Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio.
Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio.
J Surg Res. 2019 Nov;243:488-495. doi: 10.1016/j.jss.2019.06.021. Epub 2019 Aug 1.
Prior studies of the impact of the Affordable Care Act on reimbursement for inpatient trauma care do not include disproportionate share hospital (DSH) funding. Because trauma centers and other safety-net hospitals are sensitive to any changes in financial support, it is essential to include DSH funding in evaluating overall reimbursement. This study analyzes the long-term financial trends, including DSH, of a level I trauma center in Ohio, a state that expanded Medicaid.
Charges, reimbursement, sources of insurance coverage, Injury Severity Scores, and DSH funding for the trauma patient population of an Ohio American College of Surgeons level 1 trauma center were studied from 2012 to 2017. Data were collected from Transition Systems, Inc.
During 2012-2017, self-pay patient cases decreased from 15.0% to 4.1% and commercial insurance patients decreased from 34.2% to 27.6%. The percentage of Medicaid patients increased from 15.5% to 27.1%; however, Medicaid reimbursement average per case declined from $17,779 in 2012 to $10,115 in 2017 (a decline of 43.1%). Self-pay charges decreased from $22.0 million to $6.7 million. Total DSH funding, compensation given to hospitals that disproportionately treat underserved populations, decreased 17.4%.
Self-pay charges and self-pay patients decreased dramatically; Medicaid patients and charges increased substantially in the years after the implementation of the Affordable Care Act at our trauma center. However, there was a decrease in commercial insurance, which had the highest reimbursement for our hospital, and a significant decline in DSH, a critical supplemental source of funding for safety-net hospitals.
先前研究《平价医疗法案》对住院创伤护理报销的影响时并未纳入贫困医疗救助计划（DSH）资金。由于创伤中心和其他提供医疗救助的医院对财政支持的任何变化都非常敏感，因此在评估整体报销时纳入 DSH 资金至关重要。本研究分析了俄亥俄州一家一级创伤中心的长期财务趋势，包括 DSH。俄亥俄州扩大了医疗补助计划。
从 2012 年至 2017 年，对俄亥俄州美国外科医师学会一级创伤中心的创伤患者人群的收费、报销、保险覆盖来源、伤害严重程度评分和 DSH 资金进行了研究。数据由过渡系统公司收集。
在 2012-2017 年期间，自付费患者病例从 15.0%降至 4.1%，商业保险患者从 34.2%降至 27.6%。医疗补助患者的比例从 15.5%增至 27.1%；然而，医疗补助每例报销额从 2012 年的 17779 美元降至 2017 年的 10115 美元（下降 43.1%）。自付费收费从 2200 万美元降至 670 万美元。总额为 DSH 的资金，即补偿给服务不足人群比例过高的医院的资金，下降了 17.4%。
自付费收费和自付费患者数量大幅下降；在我们的创伤中心实施《平价医疗法案》后的几年中，医疗补助患者和收费大幅增加。然而，商业保险减少了，商业保险是我们医院报销额最高的保险，而 DSH 显著减少，DSH 是为提供医疗救助的医院提供的重要补充资金来源。
