June 2019 Hospitalizations for Newborns with Neonatal Abstinence Syndrome – 2018 This research brief examines newborn birth admissions involving neonatal abstinence syndrome (NAS). NAS is an array of withdrawal symptoms that develops soon after birth in newborns exposed to addictive drugs (e.g., opioids) while in the mother’s womb. The newborns experience these symptoms of withdrawal because they are no longer exposed to the drug for which they have become physically dependent. This report reflects birth admissions occurring in Pennsylvania general acute care hospitals for Pennsylvania residents during federal fiscal year (FFY) 2018: October 1, 2017 to September 30, 2018. More than 1,800 newborns affected. There were 1,833 NAS-related newborn stays in Pennsylvania in FFY 2018 for a 1,833 rate of 14.4 per 1,000 newborn stays. The rate of NAS among newborns has remained relatively stable since FFY 2016 when it was 15.2 per 1,000 newborn stays. While there was evidence of a larger number of newborns (3,354) exposed to addictive drugs before birth, not all of these babies developed NAS. More 55% specifically, in FFY 2018 NAS was diagnosed in 55% of the newborns exposed to addictive drugs before birth. $15.2 NAS-related stays added an estimated $15.2 million in hospital payments in FFY million 2018.* *Based on average payments from federal fiscal year 2017 Medicaid payment data (Oct 2016 to Sep 2017 newborn stays). This estimation assumes the payment difference between Medicaid newborn stays with NAS and all other Medicaid newborn stays is similar across all payer types, including commercial insurers, self-pay, and other. Newborns with NAS had more complications. In FFY 2018, complications such as respiratory distress, difficulty feeding, low birth weight, and prematurity were more common among newborns with NAS compared to all other newborns. Rates of Complication, by Type in Newborn Stays, FFY 2018 24.4% 16.6% 15.7% 15.3% 10.0% 9.0% 6.8% 4.1% Respiratory Distress Difficulty Feeding Low Birth Weight Prematurity Newborn Stays with NAS All Other Newborn Stays Pennsylvania Health Care Cost Containment Council 1 Newborns with NAS had longer hospital stays. In FFY 2018, the average hospital stay for newborns with NAS was 15.9 days, or 15.9 nearly five times the average stay of 3.4 days for all other newborn stays. Overall, this difference accounted for approximately 23,000 additional 23,000 days in the hospital for newborns with NAS. 5.1% These additional days represented an estimated 5.1% of the total hospital days for all newborn stays. Newborns with NAS were:  Less likely to be discharged home. In FFY 2018, newborn stays involving NAS were discharged to home 70% of the time, compared to 88% of all other newborn stays. Newborn Stays by Discharge Status, FFY 2018 1.1% 1.5% 0.5% 8.8% 9.8% Home* 19.7% † Home with additional HSO Transfer to another hospital 70.4% 88.1% Other * Includes discharge to home or foster care † l Newborn Stays with NAS All Other Newborn Stays Home health service organization care  More likely to have hospital stays paid by Medicaid. In FFY 2018, Medicaid was the anticipated primary payer in 89% of NAS-related hospital stays, compared to 41% of all other newborn stays. Newborn Stays by Payer, FFY 2018 1.5% 4.5% 9.3% Medicaid 41.2% Commercial 54.3% ‡ 89.3% Other ‡ Newborn Stays with NAS All Other Newborn Stays Includes self-pay Note: Pie chart percentages may not add exactly to 100% due to rounding. Pennsylvania Health Care Cost Containment Council 2 Demographic Differences – Newborn Stays with NAS Statewide NAS Rate: 14.4 per 1,000 Newborn Stays in FFY 2018 Rural versus urban NAS Rate per 1,000 Newborn Stays by Rural versus Urban Counties, FFY 2018 NAS rates were highest among residents of 20.3 rural counties. Urban counties include: Allegheny, Beaver, Berks, Bucks, Chester, Cumberland, Dauphin, Delaware, 12.6 Erie, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Montgomery, Northampton, Philadelphia, Westmoreland, and York. All other Pennsylvania counties Rural Urban are considered rural. (Source: Center for Rural PA) Statewide NAS Rate: 14.4 Race and ethnicity NAS Rate per 1,000 Newborn Stays by Race and Ethnicity, FFY 2018 18.0 NAS rates were highest among white, non- Hispanic newborns. 9.5 Rates were calculated based on the total number of newborn stays 5.9 (PHC4 hospital admission data). Black, non-Hispanic Hispanic White, non-Hispanic Statewide NAS Rate: 14.4 Household income NAS Rate per 1,000 Newborn Stays by Household Income, FFY 2018 19.5 NAS rates varied by 17.4 15.5 household income. The annual median household incomes were approximated at the 13.4 community level (patient zip code) using the most recent (2017) 9.3 estimates provided by the U.S. 6.2 Census Bureau’s American Community Survey. Under $40k $40k-<$50k $50k-<$60k $60k-<$70k $70k-<$80k $80k+ Statewide NAS Rate: 14.4 Pennsylvania Health Care Cost Containment Council 3 Newborn Stays paid by Medicaid, FFY 2017* Payments and Readmissions About PHC4 Created by the PA General Assembly Average Payments for Newborn Stays in 1986, the PA Health Care Cost Containment Council (PHC4) is an Newborns with NAS $12,315 independent state agency charged with collecting, analyzing and All Other Newborns $4,041 reporting information that can be used to improve the quality and restrain the cost of health care in Percent Readmitted within 30 Days the state. Today, PHC4 is a recognized national leader in public Newborns with NAS 3.6% health care reporting. PHC4 is governed by a 25-member board of All Other Newborns 2.4% directors, representing business, labor, consumers, health care providers, insurers and state Average Length of Stay for Readmissions government. Newborns with NAS 9.5 days Joe Martin, Executive Director All Other Newborns 225 Market Street, Suite 400, 5.0 days Harrisburg, PA 17101 717-232-6787 www.phc4.org * Based on federal fiscal year 2017 Medicaid payment data (Oct 2016 to Sep 2017 newborn stays). Rate of Neonatal Abstinence Syndrome per 1,000 Newborn Stays by County of Residence, FFY 2018 Not Reported due to Low Volume Erie 0.0 10.0 20.0 30.0 40.0+ 10.8 Warren McKean Susquehanna 13.0 Tioga Bradford 27.3 Crawford 22.6 6.0 Potter 7.2 27.0 Wayne 12.9 Forest Wyoming Venango Elk Cameron Sullivan 33.1 63.0 Lackawanna Mercer 24.3 Pike Lycoming 27.9 31.2 Clinton 13.3 Clarion 11.5 8.9 Jefferson Luzerne 9.2 Columbia 18.1 Monroe Lawrence Montour 7.5 16.9 Clearfield Union 36.7 Butler 19.7 Centre 6.1 Carbon 18.3 Armstrong 5.6 16.8 26.5 Northumberland Beaver Snyder Northampton 14.8 6.1 8.4 Schuylkill 7.7 Indiana 16.6 Lehigh 19.0 7.9 Allegheny Mifflin Juniata Cambria Blair 11.7 16.0 23.3 23.9 Perry Berks 26.8 Dauphin Lebanon 8.6 6.6 Bucks Westmoreland 12.9 18.9 Huntingdon Washington 17.3 16.1 Montgomery 16.1 Cumberland 6.4 7.9 Lancaster Somerset Bedford 10.1 10.1 Chester Fayette 13.7 Franklin 9.5 Delaware Philadelphia 49.7 Fulton Adams York 13.8 Greene 25.2 15.0 15.1 12.4 Statewide NAS Rate: 14.4 per 1,000 newborn stays Pennsylvania Health Care Cost Containment Council 4 Rate of Neonatal Abstinence Syndrome per 1,000 Newborn Stays by County of Residence, FFY 2018 Number of NAS Rate per 1,000 Number of NAS Rate per 1,000 Stays Newborn Stays Stays Newborn Stays Statewide 1,833 14.4 Juniata NR NR Adams 13 15.1 Lackawanna 48 24.3 Allegheny 202 16.0 Lancaster 57 10.1 Armstrong 13 26.5 Lawrence 32 36.7 Beaver 23 14.8 Lebanon 19 12.9 Bedford NR 10.1 Lehigh 32 7.9 Berks 29 6.6 Luzerne 59 18.1 Blair 28 23.9 Lycoming 16 13.3 Bradford NR 6.0 McKean NR 22.6 Bucks 88 18.9 Mercer 31 31.2 Butler 33 18.3 Mifflin NR 11.7 Cambria 28 23.3 Monroe 24 16.9 Cameron NR NR Montgomery 53 6.4 Carbon NR 16.8 Montour NR NR Centre NR 5.6 Northampton 23 7.7 Chester 45 9.5 Northumberland NR 8.4 Clarion NR 8.9 Perry 12 26.8 Clearfield 13 19.7 Philadelphia 284 13.8 Clinton NR 11.5 Pike NR 27.9 Columbia NR 7.5 Potter NR NR Crawford 22 27.0 Schuylkill 21 16.6 Cumberland 19 7.9 Snyder NR 6.1 Dauphin 28 8.6 Somerset NR 13.7 Delaware 95 15.0 Sullivan NR NR Elk 17 63.0 Susquehanna NR 27.3 Erie 30 10.8 Tioga NR 7.2 Fayette 59 49.7 Union NR 6.1 Forest NR NR Venango 14 33.1 Franklin 35 25.2 Warren NR 13.0 Fulton NR NR Washington 33 16.1 Greene 16 NR Wayne NR 12.9 Huntingdon NR 16.1 Westmoreland 50 17.3 Indiana 13 19.0 Wyoming NR NR Jefferson NR 9.2 York 55 12.4 NR: Not reported due to low volume of newborn stays and/or newborns stays with neonatal abstinence syndrome. Pennsylvania Health Care Cost Containment Council 5