486 - Cost Comparison Analysis of Pediatric Dental Sedation in Georgia vs Texas for Medicaid Policy Change

Purpose: To examine the expenditure of delivering pediatric dental sedation to Medicaid eligible children ages zero to twenty-one years old in the operating room (OR), in-office general anesthesia (GA) and in-office intravenous sedation (IV) in Georgia vs Texas, and to determine any fiscal benefit to support policy change implementation.

Methods: An open records request of Medicaid expenditures for State Fiscal Year 2019 was completed in each state. Current Medicaid pediatric sedation policies for two different states, as well as current literature regarding the comprehensive cost of pediatric sedation were reviewed. Traveling anesthesia groups that operate in both states were contacted to obtain their in-office intravenous/general anesthesia sedation costs. This data was analyzed and compared to determine the comprehensive costs of delivering sedation services in the operating room versus in-office.

Results: Georgia Medicaid had 35,994 cases that required sedation above OCS to properly treat dental needs in SFY 2019-- 16% were office based deep sedation/GA, 56% were office based IV sedations, and 28% were hospital calls.
Texas Medicaid had 54,074 cases that required sedation above OCS to properly treat dental needs in SFY 2019-- 29% were office based deep sedation/GA, 19% were office based IV sedations, and 52% were hospital calls. For Georgia, the reimbursement per claim for office-based GA (first 15 minutes) is $106.2 and for office-based IV sedation (first 15 minutes) is $321.58. For Texas, the reimbursement per claim for office-based GA (first 15 minutes) is $71.05 and for office-based IV sedation (first 15 minutes) is $56.85. Literature review found the average cost savings to be around $5000 for in-office GA compared to hospital based.

Conclusions: In Georgia, there is more utilization of in-office IV compared to Texas, 56% versus 19%, respectively. This is likely due to the fact that Georgia reimburses more for in-office IV and GA compared to Texas, and there is policy to try in-office sedation prior to hospital GA. There is potential cost savings for Texas Medicaid if policy to reform sedation reimbursement is introduced.