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Affordable Care Act's Medicaid Expansion on Use of Regionalized Surgery at High-Volume Hospitals.

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Citation: Journal of the American College of Surgeons. 2018 Sep 06PMID: 30219570Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2018 Local holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007ISSN:

1072-7515

Name of journal: Journal of the American College of SurgeonsAbstract: BACKGROUND: The Affordable Care Act (ACA)'s Medicaid expansion has increased access to surgical care overall. Whether it was associated with reduced disparities in utilization of regionalized surgery at high volume hospitals (HVH) remains unknown. Quasi-experimental evaluations of this expansion were performed to examine the utilization of regionalized surgery at HVH among racial/ethnic minorities and low-income populations.CONCLUSIONS: Early findings from ACA's Medicaid expansion revealed no impact on the utilization rates of regionalized surgery at HVH overall or on disparities among vulnerable populations. While these results need ongoing evaluation, they highlight potential limitations in ACA's expansion in reducing disparities in utilization of regionalized surgical care.Copyright (c) 2018. Published by Elsevier Inc.RESULTS: Overall, ACA's expansion was not associated with accelerated utilization rates of regionalized surgical procedures at HVH (OR 1.016, p=0.297). Disparities in utilization of regionalized surgical procedures at HVH among ethnic/racial minorities and low-income populations were unchanged; minority vs. white (OR 1.034 p value= 0.100); low-income vs. high-income (OR 1.034, p = 0.122).STUDY DESIGN: Data from State Inpatient Databases (2012-2014), American Hospital Association Annual Survey Database, and Area Resource File from Health Resources and Services Administration, were used to examine 166,558 non-elderly (ages 18-64) adults at 468 hospitals who underwent one of four regionalized surgical procedures in three expansion (KY, MD, NJ) and two non-expansion states (NC, FL). HVH thresholds were defined using the top quintile of visits per year. Interrupted time series were performed to measure the impact of expansion on utilization rates of regionalized surgery at HVH overall, by race/ethnicity, and by income.All authors: Ahluwalia JS, Al-Refaie W, Chan K, Crocker A, DeLeire T, Ehsan A, McDermott J, Shara N, Xiao D, Zeymo AFiscal year: FY2019Digital Object Identifier:

https://dx.doi.org/10.1016/j.jamcollsurg.2018.08.693

Date added to catalog: 2018-09-28

Holdings ( 1 )
Title notes ( 7 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	30219570	Available		30219570

Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007

BACKGROUND: The Affordable Care Act (ACA)'s Medicaid expansion has increased access to surgical care overall. Whether it was associated with reduced disparities in utilization of regionalized surgery at high volume hospitals (HVH) remains unknown. Quasi-experimental evaluations of this expansion were performed to examine the utilization of regionalized surgery at HVH among racial/ethnic minorities and low-income populations.

CONCLUSIONS: Early findings from ACA's Medicaid expansion revealed no impact on the utilization rates of regionalized surgery at HVH overall or on disparities among vulnerable populations. While these results need ongoing evaluation, they highlight potential limitations in ACA's expansion in reducing disparities in utilization of regionalized surgical care.

RESULTS: Overall, ACA's expansion was not associated with accelerated utilization rates of regionalized surgical procedures at HVH (OR 1.016, p=0.297). Disparities in utilization of regionalized surgical procedures at HVH among ethnic/racial minorities and low-income populations were unchanged; minority vs. white (OR 1.034 p value= 0.100); low-income vs. high-income (OR 1.034, p = 0.122).

STUDY DESIGN: Data from State Inpatient Databases (2012-2014), American Hospital Association Annual Survey Database, and Area Resource File from Health Resources and Services Administration, were used to examine 166,558 non-elderly (ages 18-64) adults at 468 hospitals who underwent one of four regionalized surgical procedures in three expansion (KY, MD, NJ) and two non-expansion states (NC, FL). HVH thresholds were defined using the top quintile of visits per year. Interrupted time series were performed to measure the impact of expansion on utilization rates of regionalized surgery at HVH overall, by race/ethnicity, and by income.

English