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

Abstract

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

The potential impact of the Affordable Care Act and Medicaid expansion on reducing colorectal cancer screening disparities in African American males

“…Individual-based simulation models were used prior to ACA to estimate potential impacts on enrollment and insurances rates [9][10][11]. However, few studies have used the methods to estimate impacts of ACA on preventable health outcomes such as colorectal cancer (CRC) [12,13]. CRC is an ideal condition for which to study using simulation because investments in screening can have long-term implications on CRC incidence and mortality outcomes that are not captured by only a few years of short-term observational data.…”

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“…Trauma care has become increasingly profitable with the expansion of health insurance coverage. 34 At the same time overall reimbursement has fallen, and hospitals left in a lurch may see trauma care as an opportunity. 35 Furthermore, certain states provide financial incentives to hospitals to become trauma centers.…”

Financial Stability of Level I Trauma Centers Within Safety-Net Hospitals

“…The estimated average reimbursement rate for indigent trauma care is less than $0.20 for every $1 of costs. 15 Conversely, the rate of uninsured patients within nonprofit SNHs was only 9%, and these sites demonstrated similar patient mix and financial stability to non SNHs providing trauma care. Safety-net hospitals have also historically relied on external subsidies, such as DSH funds, to support their operating margins; however, we found these to be less contributory than expected to the overall hospital profitability.…”