The Financial Impact of the Affordable Care Act on a Level-1 Orthopedic Trauma Service

Beck, Chad; Shelton, Trevor J.; Wisner, David H.; Wolinsky, Philip R

doi:10.1097/bot.0000000000001374

Cited by 6 publications

(6 citation statements)

References 8 publications

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“…Our study also suggests that among all patients post-ACA implementation, there was a significant increase in Medicaid patients and a significant decrease in self-pay patients compared with patients pre-ACA. Similar to the results of the present study, a retrospective cohort study by Beck et al28 of the financial impact of the ACA on payer type and professional fees showed a significant increase in the percentage of outpatients with Medicaid (23% vs. 13%), as well as a decrease in county insurance (2% vs. 0%) and self-pay (3% to 1%).…”

Section: Discussionsupporting

confidence: 91%

The Impact of the Affordable Care Act on Outpatient Spine Trauma Consult Follow-up

Canseco

Karamian

Patel

et al. 2021

Clinical Spine Surgery: A Spine Publication

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The objective of this study was to assess the impact of the Affordable Care Act (ACA) on spine trauma patient followup.Summary of Background Data: Although damage to the spinal column accounts for a small proportion of all traumatic injuries, it results in a significant burden on the patient, provider, and health care system. Postoperative follow-up is essential to direct rehabilitation, prevent early deterioration, and manage complications early in the postoperative period. Previous studies have established the role of insurance coverage on follow-up compliance, however, the impact of the ACA on follow-up has been scant. Materials and Methods:A retrospective cohort study was performed upon institutional review board approval of spine trauma patients consulted by orthopedic spine or neurosurgery from January 2013 to December 2013 (pre-ACA) and January 2015 to December 2015 (post-ACA). Patient demographics, surgical case characteristics, and follow-up compliance were assessed via manual chart review. Multivariate regression analysis was used to identify predictors of follow-up in the overall cohort, as well as within nonoperative and operative patients.Results: A total of 827 patients were included in the final analysis after inclusion and exclusion criteria. Overall, patient follow-up significantly increased after implementation of the ACA (P < 0.001), with pre-ACA follow-up at 35.0% (144/411) and post-ACA follow-up at 50.0% (208/516). Multivariate regression analysis further corroborated these findings, showing post-ACA status associated with a 1.66-fold higher likelihood of follow-up. Among nonoperative patients, the ACA failed to make a significant difference in follow-up (P = 0.56), however, patients treated operatively showed a significantly higher likelihood of follow-up (odds ratio = 2.92, P < 0.001).Conclusions: Postoperative follow-up is an essential part of patient care, aiding in improving clinical outcomes and limiting the economic burden on the health care system. This study suggests that passage of the ACA significantly improved patient follow-up for operatively managed patients but not for nonoperatively managed patients.

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Section: Discussionsupporting

confidence: 91%

The Impact of the Affordable Care Act on Outpatient Spine Trauma Consult Follow-up

Canseco

Karamian

Patel

et al. 2021

Clinical Spine Surgery: A Spine Publication

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“…noted a significant increase in orthopaedic utilization and Medicaid enrollment after ACA implementation. However, other studies have found that despite decreases in the uninsured rate, access to orthopaedic care remains limited among patients with Medicaid 7,11,12. These data indicate that access to MRI services expanded in the Medicaid population after implementation of the ACA, but at the cost of increased delays.…”

Section: Discussionmentioning

confidence: 86%

“…However, other studies have found that despite decreases in the uninsured rate, access to orthopaedic care remains limited among patients with Medicaid. 7,11,12 These data indicate that access to MRI services expanded in the Medicaid population after implementation of the ACA, but at the cost of increased delays. Finally, approximately two-thirds of the scans in this study were performed after 2014, which may be because the authors' institution added a second MRI machine in 2013-2014 that essentially doubled scanning capacity.…”

Section: Discussionmentioning

confidence: 88%

Shoulder MRI lag times after implementation of the Affordable Care Act (ACA): a retrospective review

Fryberger

Harper

Brolin

et al. 2022

Current Orthopaedic Practice

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Background:With the Affordable Care Act (ACA), the challenge of expanding healthcare insurance to Americans without jeopardizing quality of care remains. This study was initiated to evaluate how the timing of MRI completion for shoulder pathology correlates with implementation of the ACA by comparing lag times between the initial visit and the date of MRI completion. In addition, the access to orthopaedic care after ACA implementation was evaluated by comparing shoulder MRI lag times among three cohorts based on insurer status. Methods:All shoulder and proximal upper extremity MRIs between 2009 and 2017 were reviewed, 5 yr before and 3 yr after ACA implementation. Patients were grouped into commercial, Medicare, and Medicaid cohorts. Average lag times for the pre-and post-ACA periods overall and among payor cohorts were calculated. Results:Included were 5900 MRIs, 1997 (33.8%) before and 3903 (66.2%) after ACA implementation. The difference in payor mix before and after ACA implementation was significantly different (P < 0.001). Median lag time increased from 23 days pre-ACA to 31 days post-ACA (P < 0.001). For commercial insurance, median lag time was 23 days pre-ACA compared with 28 days (P < 0.001) post-ACA. Median lag time pre-and post-ACA in the Medicaid cohort was 8 days compared with 30.5 days (P < 0.001), respectively. Pre-and post-ACA lag times in the Medicare cohort did not differ significantly (P = 0.450). Conclusions:Lag times increased significantly after ACA implementation in patients with commercial and Medicaid insurance. This study provides valuable insight into unintended outcomes associated with the ACA legislation.

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“…11 Beck et al not only encountered fewer uninsured patients at a level 1 trauma center after the ACA was enacted but also reported decreases in collection rates from government-based payers in that time period. 14 For orthopaedic surgeons, a useful surrogate for quantifying changes in practice since ACA implementation would be common, measurable, and unbiased in patient selection. Knee pain has consistently been the most common presenting report in the orthopaedic office.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Delay in Knee MRI Scan Completion Since Implementation of the Affordable Care Act:

Holt

Duncan

Smith

et al. 2022

J Am Acad Orthop Surg

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Introduction:The most impactful resolutions of the Patient Protection and Affordable Care Act (ACA) took effect on January 1, 2014. The clinical and economic effects are widely experienced by orthopaedic surgeons, but are not well quantified. We proposed to evaluate the effect of the ACA on the timing of MRI for knee pathology before and after implementation of the legislation.Methods: We conducted a retrospective analysis of all knee MRIs done at our institution from 2011 to 2016 (3 years before and after ACA implementation). The MRI completion time was calculated by comparing the dates of initial clinical evaluation and MRI completion. The groups were subdivided based on insurance payer status (Medicare, Medicaid, and commercial payers). The cohorts were compared to determine differences in average completion time and completion rates at time intervals from initial clinic visit before and after ACA implementation.Results: MRI scans of 5,543 knees were included, 3,157 (57%) before ACA implementation and 2,386 (43%) after. There was a 5.6% increase in Medicaid cohort representation after ACA implementation. Patients waited 14 days longer for MRIs after ACA implementation (116 versus 102 days). There were increased completion times for patients in the commercial payer (113 versus 100 days) and Medicaid (131 versus 96 days) groups. Fewer patients had received MRI after ACA implementation within 2, 6, and 12 weeks of their initial clinic visits.Discussion: The time between initial clinical evaluation and MRI scan completion for knee pathology markedly increased after ACA implementation, particularly in the commercial payer and Medicaid cohorts. Additional studies are needed to determine the effect of longer wait times on patient satisfaction, delayed treatment, and increased morbidity. As healthcare policy changes continue, their effects on orthopaedic patients and providers should be closely scrutinized.

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The Financial Impact of the Affordable Care Act on a Level-1 Orthopedic Trauma Service

Cited by 6 publications

References 8 publications

The Impact of the Affordable Care Act on Outpatient Spine Trauma Consult Follow-up

The Impact of the Affordable Care Act on Outpatient Spine Trauma Consult Follow-up

Shoulder MRI lag times after implementation of the Affordable Care Act (ACA): a retrospective review

Delay in Knee MRI Scan Completion Since Implementation of the Affordable Care Act:

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