Joseph Bellal, Haider Ansab A, Azim Asad, Kulvatunyou Narong, Tang Andrew, OʼKeeffe Terence, Latifi Rifat, Green Donald J, Friese Randall S, Rhee Peter
From the Division of Trauma, and Acute Care Surgery; Department of Surgery (B.J., A.A.H., A.A., N.K., A.T., TO'K., R.L., D.J.G., R.S.F., P.R.), University of Arizona Medical Center, Tucson, Arizona.
J Trauma Acute Care Surg. 2016 Sep;81(3):427-34. doi: 10.1097/TA.0000000000001082.
The Patient Protection and Affordable Care Act (ACA) was implemented to guarantee financial coverage for health care for all Americans. The implementation of ACA is likely to influence the insurance status of Americans and reimbursement rates of trauma centers. The aim of this study was to assess the impact of ACA on the patient insurance status, hospital reimbursements, and clinical outcomes at a Level I trauma center. We hypothesized that there would be a significant decrease in the proportion of uninsured trauma patients visiting our Level I trauma center following the ACA, and this is associated with improved reimbursement.
We performed a retrospective analysis of the trauma registry and financial database at our Level I trauma center for a 27-month (July 2012 to September 2014) period by quarters. Our outcome measures were change in insurance status, hospital reimbursement rates (total payments/expected payments), and clinical outcomes before and after ACA (March 31, 2014). Trend analysis was performed to assess trends in outcomes over each quarter (3 months).
A total of 9,892 patients were included in the study. The overall uninsured rate during the study period was 20.3%. Post-ACA period was associated with significantly lower uninsured rate (p < 0.001). During the same time, there was as a significant increase in the Medicaid patients (p = 0.009). This was associated with significantly improved hospital reimbursements (p < 0.001).On assessing clinical outcomes, there was no change in hospitalization (p = 0.07), operating room procedures (p = 0.99), mortality (p = 0.88), or complications (p = 0.20). Post-ACA period was also not associated with any change in the hospital (p = 0.28) or length of stay at intensive care unit (p = 0.66).
The implementation of ACA has led to a decrease in the number of uninsured trauma patients. There was a significant increase in Medicaid trauma patients. This was associated with an increase in hospital reimbursements that substantially improved the financial revenues. Despite the controversies, implementation of ACA has the potential to substantially improve the financial outcomes of trauma centers through Medicaid expansion.
Economic and value-based evaluation, level III.
《患者保护与平价医疗法案》（ACA）的实施旨在确保所有美国人都能获得医疗保健的经济保障。ACA的实施可能会影响美国人的保险状况以及创伤中心的报销率。本研究的目的是评估ACA对一级创伤中心患者保险状况、医院报销以及临床结局的影响。我们假设，ACA实施后，到我们一级创伤中心就诊的未参保创伤患者比例将显著下降，且这与报销改善相关。
我们对一级创伤中心27个月（2012年7月至2014年9月）期间按季度划分的创伤登记和财务数据库进行了回顾性分析。我们的结局指标是ACA实施前后（2014年3月31日）保险状况的变化、医院报销率（总支付/预期支付）以及临床结局。进行趋势分析以评估每个季度（3个月）结局的趋势。
本研究共纳入9892例患者。研究期间总体未参保率为20.3%。ACA实施后未参保率显著降低（p<0.001）。同时，医疗补助患者显著增加（p = 0.009）。这与医院报销显著改善相关（p<0.001）。在评估临床结局时，住院情况（p = 0.07）、手术室手术（p = 0.99）、死亡率（p = 0.88）或并发症（p = 0.20）均无变化。ACA实施后，医院（p = 0.28）或重症监护病房住院时间（p = 0.66）也无任何变化。
ACA的实施导致未参保创伤患者数量减少。医疗补助创伤患者显著增加。这与医院报销增加相关，大幅改善了财务收入。尽管存在争议，但通过扩大医疗补助，ACA的实施有可能显著改善创伤中心的财务结局。
基于经济和价值的评估，三级。
