Anticipating the Impact of Insurance Expansion on Inpatient Urological Surgery

Ellimoottil, Chandy; Miller, Sarah; Wei, John T.; Miller, David C.

doi:10.1016/j.urpr.2014.05.002

Cited by 6 publications

(6 citation statements)

References 31 publications

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“…Ellimoottil et al examined urological surgeries in Massachusetts after the reform. 5 Although they found an increase in nonwhite and low-income patients undergoing surgeries, there was no significant change in overall urological surgeries. 5 Previous data and our study show that in certain specialties, mandated health care insurance does not result in increased case totals.…”

Section: Discussionmentioning

confidence: 94%

“…5 Although they found an increase in nonwhite and low-income patients undergoing surgeries, there was no significant change in overall urological surgeries. 5 Previous data and our study show that in certain specialties, mandated health care insurance does not result in increased case totals. The most likely explanation for this finding is that most clinical conditions that require neurosurgical procedures are sufficiently urgent that patients present themselves for care irrespective of their insurance coverage.…”

Section: Discussionmentioning

confidence: 94%

“…Several studies have used the 2006 Massachusetts health care policy as a model to predict the impact of the ACA. 4,5,8 To our knowledge, this is the first study to examine the impact of this reform on neurological surgery as a whole. Our data show a significant decrease in the percentages of uninsured individuals undergoing all categories of neurosurgical procedures in Massachusetts after its health care policy change.…”

Section: Discussionmentioning

confidence: 98%

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Impact of the 2006 Massachusetts health care insurance reform on neurosurgical procedures and patient insurance status

Villelli

Das

Hong

et al. 2017

JNS

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OBJECTIVE The Massachusetts health care insurance reform law passed in 2006 has many similarities to the federal Affordable Care Act (ACA). To address concerns that the ACA might negatively impact case volume and reimbursement for physicians, the authors analyzed trends in the number of neurosurgical procedures by type and patient insurance status in Massachusetts before and after the implementation of the state's health care insurance reform. The results can provide insight into the future of neurosurgery in the American health care system. METHODS The authors analyzed data from the Massachusetts State Inpatient Database on patients who underwent neurosurgical procedures in Massachusetts from 2001 through 2012. These data included patients' insurance status (insured or uninsured) and the numbers of procedures performed classified by neurosurgical procedural codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Each neurosurgical procedure was grouped into 1 of 4 categories based on ICD-9-CM codes: 1) tumor, 2) other cranial/vascular, 3) shunts, and 4) spine. Comparisons were performed of the numbers of procedures performed and uninsured patients, before and after the implementation of the reform law. Data from the state of New York were used as a control. All data were controlled for population differences. RESULTS After 2008, there were declines in the numbers of uninsured patients who underwent neurosurgical procedures in Massachusetts in all 4 categories. The number of procedures performed for tumor and spine were unchanged, whereas other cranial/vascular procedures increased. Shunt procedures decreased after implementation of the reform law but exhibited a similar trend to the control group. In New York, the number of spine surgeries increased, as did the percentage of procedures performed on uninsured patients. Other cranial/vascular procedures decreased. CONCLUSIONS After the Massachusetts health care insurance reform, the number of uninsured individuals undergoing neurosurgical procedures significantly decreased for all categories, but more importantly, the total number of surgeries performed did not change dramatically. To the extent that trends in Massachusetts can predict the overall US experience, we can expect that some aspects of reimbursement may be positively impacted by the ACA. Neurosurgeons, who often treat patients with urgent conditions, may be affected differently than other specialists.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 98%

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Impact of the 2006 Massachusetts health care insurance reform on neurosurgical procedures and patient insurance status

Villelli

Das

Hong

et al. 2017

JNS

View full text Add to dashboard Cite

show abstract

“…Ellimoottil et al also showed a decrease in urologi- cal surgeries performed in those between 19 and 40 years of age after the Massachusetts reform. 4 These results suggest that despite the younger generation having more access to health insurance, there has not been an increase in surgeries for the Medicaid and younger populations.…”

Section: Discussionmentioning

confidence: 96%

The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age

Villelli

Hong

Zou

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVESeveral similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors’ prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US.METHODSUsing the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers’ compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control.RESULTSThe authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and “other” categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65–84 years old, with a decrease in surgeries for those 18–44 years old. New York showed an increase in all insurance categories and all adult age groups.CONCLUSIONSAfter the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly population. The Massachusetts model continues to show that this type of policy is not causing extreme shifts in the payer mix, and suggests that spine surgery will continue to thrive in the current US health care system.

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“…Difference-in-differences analyses compare time trends between a treatment group and nonrandom controls to identify causal relationships. This study design can address many forms of bias and has been used, for instance, to examine the effect of insurance expansion on the use of urologic surgery [25]. In kidney cancer research, a recent study using propensity adjustment and a unique cohort of patients with solitary kidneys, which removes the influence of the contralateral kidney on renal function, has proven crucial for understanding the role of renal parenchyma preservation and ischemia time in outcomes following partial nephrectomy [22].…”

Section: Commentarymentioning

confidence: 99%

Survival benefit of partial nephrectomy: Reconciling experimental and observational data

Tan

2015

Urologic Oncology: Seminars and Original Investigations

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Anticipating the Impact of Insurance Expansion on Inpatient Urological Surgery

Cited by 6 publications

References 31 publications

Impact of the 2006 Massachusetts health care insurance reform on neurosurgical procedures and patient insurance status

Impact of the 2006 Massachusetts health care insurance reform on neurosurgical procedures and patient insurance status

The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age

Survival benefit of partial nephrectomy: Reconciling experimental and observational data

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