US Acute Care Solutions, Canton, OH.
Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA.
Ann Emerg Med. 2019 Mar;73(3):213-224. doi: 10.1016/j.annemergmed.2018.10.020. Epub 2018 Nov 22.
We examine the effect of Medicaid expansion on reimbursement for emergency physicians' professional services.
We conducted a retrospective study using data from a national emergency medicine group in a sample of 50 emergency departments (EDs) from July 1, 2012, to June 30, 2015. We categorized facilities in 14 states into full-expansion (23), partial-expansion (17), and nonexpansion (10) categories based on pre-expansion Medicaid eligibility criteria for all adults. We used a difference-in-differences design to assess the effect of Medicaid expansion on provider reimbursement per visit. Secondary outcomes included reimbursement per relative value unit and relative value units per visit, both overall and by payer type, controlling for age, sex, billing codes, and health system relationship.
We studied greater than 6.7 million ED visits during July 2012 to December 2015, 3.0 million pre-expansion and 3.7 million postexpansion. After adjusting for covariates, reimbursement per visit increased 6.3% (95% confidence interval 1.4% to 11.1%) in full-expansion relative to nonexpansion states and did not change significantly in partial-expansion versus nonexpansion states. Reimbursement per visit for commercial insurance increased 17.1% (95% confidence interval 9.9% to 24.2%) in full-expansion versus nonexpansion states. Reimbursement for self-pay visits increased 9.7% (95% confidence interval 3.7% to 15.7%) in full-expansion versus nonexpansion states. Changes in payments were driven by higher reimbursement per relative value unit; relative value units per visit declined slightly in full-expansion compared with nonexpansion states.
In this sample, full Medicaid expansion increased payments for emergency physicians' professional services compared with reimbursement in nonexpansion states. Higher reimbursement was driven primarily by lower proportions of uninsured patients and increased reimbursement per visit for both commercially insured and self-pay patients in states with full Medicaid expansion.
我们考察了医疗补助计划扩大覆盖范围对急诊医师专业服务报酬的影响。
我们采用回顾性研究方法，利用全国急诊医学组的数据，对 2012 年 7 月 1 日至 2015 年 6 月 30 日期间的 50 个急诊科进行了抽样调查。我们根据预先确定的所有成年人的医疗补助资格标准，将 14 个州的医疗机构分为全面扩张（23 个）、部分扩张（17 个）和未扩张（10 个）类别。我们采用差异法评估医疗补助计划扩大覆盖范围对每次就诊提供者报酬的影响。次要结果包括每次就诊的报酬、每相对价值单位的报酬和每就诊相对价值单位，涵盖了年龄、性别、计费代码和医疗体系关系，按支付类型进行分类。
我们研究了 2012 年 7 月至 2015 年 12 月期间超过 670 万次的急诊科就诊，其中 300 万次就诊发生在医疗补助计划扩大之前，370 万次就诊发生在之后。在调整了协变量后，与未扩张的州相比，全面扩张的州每次就诊的报酬增加了 6.3%（95%置信区间为 1.4%至 11.1%），而部分扩张的州与未扩张的州相比则没有显著变化。商业保险的每次就诊报酬增加了 17.1%（95%置信区间为 9.9%至 24.2%），在全面扩张的州与未扩张的州相比。自付就诊的报酬增加了 9.7%（95%置信区间为 3.7%至 15.7%），在全面扩张的州与未扩张的州相比。支付的变化是由每相对价值单位更高的报酬驱动的；与未扩张的州相比，全面扩张的州每次就诊的相对价值单位略有下降。
在本样本中，与未扩张的州相比，全面的医疗补助计划增加了急诊医师专业服务的报酬。较高的报酬主要是由未参保患者比例降低以及全面扩张的州中商业保险和自付患者的每次就诊报酬增加所驱动的。
