Addressing Medicaid Expansion from the Perspective of Patient Experience in Hospitals

Liu, Sandra S.; Wen, Yu-Ping; Mohan, Soumya; Bae, Jaeyong; Becker, Edmund R.

doi:10.1007/s40271-016-0167-y

Cited by 7 publications

(12 citation statements)

References 36 publications

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“…This suggests that financially strained hospitals that are able to substantially reduce higher than average levels of uncompensated care may see meaningful improvements in patient experience scores. This is in accordance with the literature examining the relationship between financial security and hospital quality, with evidence suggesting that quality is most affected in hospitals with deep financial problems …”

Section: Discussionsupporting

confidence: 91%

“…This is in accordance with the literature examining the relationship between financial security and hospital quality,[25][26][27][28][29][30][31][32] with evidence suggesting that quality is most affected in hospitals with deep financial problems 14. Understanding the relationship between hospital financesand patient outcomes is particularly important in the context of federal funding cuts to safety-net hospitals and new valuebased reimbursement models precipitated by the ACA.…”

supporting

confidence: 85%

“…30 Several studies have also investigated the relationship between hospital proportion of low-income patients and patient experience scores. 28,31,32 The findings from these studies indicate a positive correlation between financial health and hospital quality outcomes across a variety of measures.…”

Section: Un Compen Sated C Are Finan Cial He Alth and Qualit Ymentioning

confidence: 88%

“…Studies have also examined a hospital's proportion of low‐income patients, an indicator of hospital financial health, in relation to health outcomes, mortality rates, readmission rates, and process of care measures . Several studies have also investigated the relationship between hospital proportion of low‐income patients and patient experience scores . The findings from these studies indicate a positive correlation between financial health and hospital quality outcomes across a variety of measures.…”

Section: Uncompensated Care Financial Health and Qualitymentioning

confidence: 99%

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Hospital uncompensated care and patient experience: An instrumental variable approach

Camilleri

Diebold

2019

Health Services Research

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Objective Examine the endogenous relationship between uncompensated care and hospital patient experience scores. Data Sources/Study Setting The Hospital Consumer Assessment of Healthcare Providers and Systems Survey, CMS Healthcare Cost Report Information System, and the US Census Bureau. Study Design The exogenous change in uncompensated care caused by the 2014 Medicaid expansion was exploited to measure the effect of uncompensated care on patient experience scores using a 2SLS regression with instrumental variables approach. Data Collection/Extraction Methods U.S. general, short‐term hospitals whose DSH status remained constant and had nonmissing data for 2011‐2015, which totaled 969 unique hospitals per year. Principal Findings The effect of uncompensated care on patient experience was in the predicted direction, with three of the 10 measures being statistically significant. A one percentage point increase in uncompensated care costs resulted in a 0.25‐0.50 percentage point decrease in select patient experience scores. Conclusions Results indicate a weak relationship between uncompensated care and patient experience scores, as a reduction in uncompensated care is related to quality improvement for some hospitals. These findings have implications for hospitals as they navigate changing reimbursement structures and policy makers considering changes to Obama‐era health care reforms.

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Section: Discussionsupporting

confidence: 91%

supporting

confidence: 85%

Section: Un Compen Sated C Are Finan Cial He Alth and Qualit Ymentioning

confidence: 88%

Section: Uncompensated Care Financial Health and Qualitymentioning

confidence: 99%

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Hospital uncompensated care and patient experience: An instrumental variable approach

Camilleri

Diebold

2019

Health Services Research

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“…The low scores by Medicaid patients are consistent with other studies, 8,10,12,13 including one done by Liu, et al that found hospitals with more Medicaid patients received lower patient satisfaction scores. 14 Medicaid often covers the most vulnerable and disadvantaged patients.…”

Section: Discussionmentioning

confidence: 99%

Association between Payer-Class and Patient Satisfaction Scores in an Academic Urology Outpatient Clinic

et al. 2021

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Introduction: As physician reimbursement models transition from fee-for-service to valuebased purchasing, patient satisfaction is becoming an important payment modifier. Studies have shown correlation between non-modifiable patient attributes and satisfaction scores. This study aims to investigate potential patient bias in survey scores associated with payor type in an academic urology outpatient clinic setting. Materials and Methods: The survey results of 20,944 patients seen in an academic Urology clinic were analyzed, and the weighted mean ± SD scores of patient experience in five major payor categories were compared: 1)commercial insurance, 2)Medicare, 3)Medicaid, 4)other government plans, 5)Workman's comp, and 6)self-pay/uncompensated. ANOVA and Tukey-Kramer Honestly Significant Difference were utilized to assess statistical significance. Results: Medicare patients reported the highest satisfaction scores (93.03), followed by other government coverage (91.49), commercial insurance (91.32), Workman's Comp (90.72), Medicaid (89.21), and self-pay/uncompensated (89.00). ANOVA analysis resulted in an F value of 40.198 (p<0.001). Tukey-Kramer demonstrated statistical significance in the difference between the means of the following groups: Commercial vs. Medicaid (p<0.001), Commercial vs. Medicare (p<0.001), Commercial vs. Self-Pay/Uncompensated (p<0.01), Other Government vs. Medicaid (p<0.001), Other Government vs. Medicare (p<0.01), Medicaid vs. Medicare (p<0.001), Medicare vs. Self-Pay/Uncompensated (p<0.001). Conclusion: Our data suggest that patient experience scores are impacted by the type of coverage the patient carries and not only by the quality of care provided. Urology clinicians should be aware of these nuances when selecting MIPS quality reporting metrics. Currently,

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The experience of low-income men with prostate cancer transitioning from disease-specific coverage to comprehensive insurance under the affordable care act

Nabhani

Vargas

Kwan

et al. 2018

Journal of Cancer Policy

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Addressing Medicaid Expansion from the Perspective of Patient Experience in Hospitals

Cited by 7 publications

References 36 publications

Hospital uncompensated care and patient experience: An instrumental variable approach

Hospital uncompensated care and patient experience: An instrumental variable approach

Association between Payer-Class and Patient Satisfaction Scores in an Academic Urology Outpatient Clinic

The experience of low-income men with prostate cancer transitioning from disease-specific coverage to comprehensive insurance under the affordable care act

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