TY  - BOOK
AU  - Al-Refaie, Waddah B
AU  - Shara, Nawar M
AU  - Zeymo, Alexander
TI  - The Affordable Care Act's Medicaid expansion and utilization of discretionary vs. non-discretionary inpatient surgery
SN  - 0039-6060
PY  - 2018///
KW  - *Elective Surgical Procedures/sn [Statistics & Numerical Data]
KW  - *Medicaid
KW  - *Patient Protection and Affordable Care Act
KW  - Adolescent
KW  - Adult
KW  - Elective Surgical Procedures/ec [Economics]
KW  - Female
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - United States
KW  - Young Adult
KW  - MedStar Health Research Institute
KW  - MedStar Washington Hospital Center
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - BACKGROUND: While pre-Affordable Care Act expansions in Medicaid eligibility led to increased utilization of elective inpatient procedures, the impact of the Affordable Care Act on such preference-sensitive procedures (also known as discretionary procedures) versus time-sensitive non-discretionary procedures remains unknown. As such, we performed a hospital-level quasi-experimental evaluation to measure the differential effects of the Affordable Care Act's Medicaid expansion on utilization of discretionary procedures versus non-discretionary procedures; CONCLUSION: In this multi-state evaluation, the Affordable Care Act's Medicaid expansion preferentially increased utilization of discretionary procedures versus non-discretionary procedures in expansion states compared to non-expansion states among non-privately insured patients. These preliminary findings suggest that increased Medicaid coverage may have contributed to the increased use of inpatient surgery for discretionary procedures; Copyright (c) 2018 Elsevier Inc. All rights reserved; METHODS: The State Inpatient Database (2012-2014) yielded 476 hospitals providing selected discretionary procedures or non-discretionary procedures performed on 288,446 non-elderly, adult patients across 3 expansion states and 2 non-expansion control states. Discretionary procedures included non-emergent total knee and hip arthroplasty, while non-discretionary procedures included nine cancer surgeries. Mixed Poisson interrupted time series analyses were performed to determine the impact of the Affordable Care Act's Medicaid expansion on the number of discretionary procedures versus non-discretionary procedures provided among non-privately insured patients (Medicaid and uninsured patients) and privately insured patients; RESULTS: Analysis of the number of non-privately insured procedures showed an increase in discretionary procedures of +15.1% (IRR 1.15, 95% CI:1.11-1.19) vs -4.0% (IRR 0.96, 95% CI:0.94-0.99) and non-discretionary procedures of +4.1% (IRR 1.04, 95% CI:1.0-1.1) vs -5.3% (IRR 0.95, 95% CI:0.93-0.97) in expansion states compared to non-expansion states, respectively. Analysis of privately insured procedures showed no statistically meaningful change in discretionary procedures or non-discretionary procedures in either expansion or non-expansion states
UR  - https://dx.doi.org/10.1016/j.surg.2018.05.007
ER  -