000			04079nam a22005297a 4500
008			180818s20182018 xxu||||| |||| 00| 0 eng d
022			_a0039-6060
024			_a10.1016/j.surg.2018.05.007 [doi]
024			_aS0039-6060(18)30218-6 [pii]
040			_aOvid MEDLINE(R)
099			_a30087042
245			_aThe Affordable Care Act's Medicaid expansion and utilization of discretionary vs. non-discretionary inpatient surgery.
251			_aSurgery. 164(6):1156-1161, 2018 12.
252			_aSurgery. 164(6):1156-1161, 2018 12.
253			_aSurgery
260			_c2018
260			_fFY2019
266			_d2018-08-16
501			_aAvailable online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
520			_aBACKGROUND: 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.
520			_aCONCLUSION: 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.
520			_aCopyright (c) 2018 Elsevier Inc. All rights reserved.
520			_aMETHODS: 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.
520			_aRESULTS: 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.
546			_aEnglish
650			_a*Elective Surgical Procedures/sn [Statistics & Numerical Data]
650			_a*Medicaid
650			_a*Patient Protection and Affordable Care Act
650			_aAdolescent
650			_aAdult
650			_aElective Surgical Procedures/ec [Economics]
650			_aFemale
650			_aHumans
650			_aMale
650			_aMiddle Aged
650			_aUnited States
650			_aYoung Adult
651			_aMedStar Health Research Institute
651			_aMedStar Washington Hospital Center
657			_aJournal Article
700			_aAl-Refaie, Waddah B
700			_aShara, Nawar M
700			_aZeymo, Alexander
790			_aAl-Refaie WB, Chan K, Crocker AB, DeLeire T, Johnson LB, Shara N, Xiao D, Zeymo A
856			_uhttps://dx.doi.org/10.1016/j.surg.2018.05.007 _zhttps://dx.doi.org/10.1016/j.surg.2018.05.007
942			_cART _dArticle
999			_c3660 _d3660