Emergency Department Profits Are Likely To Continue As The Affordable Care Act Expands Coverage

Wilson, Michael B.; Cutler, David M.

doi:10.1377/hlthaff.2013.0754

Cited by 38 publications

(37 citation statements)

References 13 publications

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“…8,9,15–20 In order to build our model for post-ACA estimations we determined the following: (i) the probability that an uninsured patient would be eligible for Medicaid or private insurance coverage, (ii) the likelihood that a newly eligible patient would actually enroll in the policy, and (iii) the ratio of inpatient costs to hospital reimbursement for trauma care for different payers.…”

Section: Methodsmentioning

confidence: 99%

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Potential impact of Affordable Care Act–related insurance expansion on trauma care reimbursement

Scott

Neiman

Najjar

et al. 2017

Journal of Trauma and Acute Care Surgery

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Introduction Nearly one-quarter of trauma patients are uninsured and hospitals recoup less than 20% of inpatient costs for their care. This study examines changes to hospital reimbursement for inpatient trauma care if the full coverage expansion provisions of the Affordable Care Act (ACA) were in effect. Methods We abstracted nonelderly adults (ages 18–64y) admitted for trauma from the Nationwide Inpatient Sample (NIS) during 2010—the last year prior to most major ACA coverage expansion policies. We calculated national and facility-level reimbursements and trauma-related contribution margins using NIS-supplied cost-to-charge ratios and published reimbursement rates for each payer type. Using US census data, we developed a probabilistic microsimulation model to determine the proportion of pre-ACA uninsured trauma patients that would be expected to gain private insurance, Medicaid, or remain uninsured after full implementation of the ACA. We then estimated the impact of these coverage changes on national and facility-level trauma reimbursement for this population. Results 145,849 patients (representing 737,852 patients nationwide) were included. National inpatient trauma costs for 18–64y patients totaled $14.8 billion (95%CI:12.5,17.1). Pre-expansion reimbursements totaled $13.7 billion (10.8,14.7), yielding a national margin of −7.9% (−10.6, −5.1). Post-expansion projected reimbursements totaled $15.0 billion (12.7,17.3), increasing the margin by 9.3 absolute percentage-points to +1.4% (−0.3,+3.2). Of the 263 eligible facilities, 90 (34.2%) had a positive trauma-related contribution margin in 2010, which increased to 171 (65.0%) using post-expansion projections. Those facilities with the highest proportion of uninsured and racial/ethnic minorities experienced the greatest gains. Conclusion Health insurance coverage expansion for uninsured trauma patients has the potential to increase national reimbursement for inpatient trauma care by over one billion dollars and nearly double the proportion of hospitals with a positive margin for trauma care. These data suggest that insurance coverage expansion has the potential to improve trauma centers’ financial viability and their ability to provide care for their communities. Level of Evidence Level II: Sensible costs and alternatives; values obtained from limited sources; multi-way sensitivity analyses Study Type Policy Analysis / Economic Analysis

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Section: Methodsmentioning

confidence: 99%

“…8 To ensure that our findings were robust and not driven solely by the source of reimbursement-to-cost ratios, we used two other recently published approaches. 9,20 See the appendix for full specification of the primary model and all four sensitivity analyses.…”

Section: Methodsmentioning

confidence: 99%

Potential impact of Affordable Care Act–related insurance expansion on trauma care reimbursement

Scott

Neiman

Najjar

et al. 2017

Journal of Trauma and Acute Care Surgery

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“…Pour les responsables de l'hôpital et pour les autorités régionales de santé rencontrées, les missions de l'hôpital universitaire sont indissociables de ses missions sociales et de son ancrage territorial. Il est intéressant de noter qu'aux États-Unis les SU sont considérés comme rentables, car leurs revenus sont supérieurs de 7,8 % à leurs coûts [24], même si le système de remboursement pose actuellement des problèmes [25]. Sans aucun doute, c'est dans la gestion des lits que nous avons constaté la rupture idéologique et organisationnelle la plus importante.…”

Section: Discussionunclassified

Visite de services d’urgences en Californie. Rapport d’un groupe d’urgentistes français

Casalino

Choquet

Hellmann

et al. 2015

Ann. Fr. Med. Urgence

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Introduction : Améliorer la qualité des services d'urgences (SU) est une priorité. Le benchmarking et les méthodes qualitatives ont été proposés comme des outils d'amélioration de la qualité en santé. Notre objectif est de décrire l'application de ces méthodes aux SU. Méthode : Des SU universitaires situés en Californie ont été visités. Des questionnaires semi-structurés ont été utilisés pour les entretiens avec les responsables et les personnels des SU, sur les aspects organisationnels, dont le triage et les filières de soins internes ; les moyens humains ; les équipe-ments ; les projets qualité et performance ; les indicateurs qualité et de tension ; les liens transversaux des urgences avec le reste de l'hôpital ; la gestion des lits ; les soins axés sur les patients. Des responsables régionaux de santé ont été égale-ment interviewés. Résultats : Trois SU adultes et deux SU pédiatriques ont été visités ; 56 responsables et personnels des SU ont été interviewés. Nous avons identifié de nombreux aspects organisationnels et de gestion innovants, parmi eux le rôle des nursepractitionners (NP), l'importance des filières courtes dans l'organisation des SU et l'organisation des filières pour les urgences vitales. L'architecture, l'organisation et les projets de soins sont au service du projet qualité. La sécurité est apparue comme une priorité tout comme la réduction des délais d'attente et l'information. La gestion des lits et l'organisation de celle-ci traduisent une culture hospitalière accordant la priorité aux filières non programmées. Conclusion : La visite de SU à l'étranger dans le cadre de visites structurées, en utilisant des méthodes managériales et scientifiques validées, a permis d'identifier des pistes d'amé-lioration de la qualité des soins et des conditions de travail des équipes des SU.Abstract Introduction: Improving the quality of care in Emergency Departments (ED) is a priority. Benchmarking and qualitative methods have been applied as health quality improvement tools. Our goal is to describe the application of these methods. Method: University EDs located in California were visited. Semi-structured questionnaires were used for interviews with ED managers and staff members, on the organizational aspects, including triage and care pathways; human resources; equipment; quality and performance indicators; transverse links between ED and hospital wards; bed management; and patients-centered care. District health officials were also interviewed. Results: Three adult and two pediatric EDs were visited; 56 ED leaders and staff members were interviewed. We have identified many innovative organizational and management aspects such as the role of nurse-practitioners, the importance of fast-track in the organization of ED, and the critical care area project. The architecture, organization, and care projects are at the service of the ED quality project. Security has emerged as a priority in reducing waiting times. Bed management and ED-hospital culture reflect a growing priority and provided the through-ED pat...

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“…One good example can be found in emergency departments. While Medicare use a fixed-fee based system for reimbursing inpatient hospitalizations and outpatient emergency department visits, private insurers use various ways of reimbursement including a per diem basis, providing higher profits for hospitals than Medicare [37]. Given that those visiting emergency department are severely ill and thus much costly to treat, having many Medicare patients in emergency department will generate high costs, negatively affecting profitability even more.…”

Section: Medicare Patients (Mcar)mentioning

confidence: 99%

A Kitchen with too Many Cooks: Factors Associated with Hospital Profitability

Cho

Hong

2018

Sustainability

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Abstract:In this paper, we carefully investigate previous literature to extract 10 relevant factors to explain the hospital profitability and build an econometrically well-specified model of explaining hospital profitability that does not suffer from omitted variable bias. Then we provide empirical evidence to a common belief that the objective function of a hospital varies with the type of hospital. We identified distinct objective functions for three types of hospitals: for-profit hospitals are driven by the overarching agreed-upon goal of profit maximization for shareholders; government hospitals, which are often the insurers of last resort, are obliged to put the public interest over profit objectives; nonprofit hospitals, which are legally prohibited from distributing profits, occupy the middle ground between for-profit and government hospitals. The results of this paper suggest that the ownership type should determine the factors on which hospitals focus and hence are useful to hospital management and academic researchers.

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Emergency Department Profits Are Likely To Continue As The Affordable Care Act Expands Coverage

Cited by 38 publications

References 13 publications

Potential impact of Affordable Care Act–related insurance expansion on trauma care reimbursement

Potential impact of Affordable Care Act–related insurance expansion on trauma care reimbursement

Visite de services d’urgences en Californie. Rapport d’un groupe d’urgentistes français

A Kitchen with too Many Cooks: Factors Associated with Hospital Profitability

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