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Impact of Health Policy Changes on Emergency Medicine in Maryland Stratified by Socioeconomic Status

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: On January 1, 2014, the financing and delivery of healthcare in the state of Maryland (MD) profoundly changed. The insurance provisions of the Patient Protection and Affordable Care Act (ACA) began implementation and a major revision of MD’s Medicare waiver ushered in a Global Budget Revenue (GBR) structure for hospital reimbursement. Our objective was to analyze the impact of these policy changes on emergency department (ED) utilization, hospitalization practices, insurance profiles, and professional revenue. We stratified our analysis by the socioeconomic status (SES) of the ED patient population.

Methods: We collected monthly mean data including patient volume, hospitalization percentages, payer mix, and professional revenue from January 2013 through December 2015 from a convenience sample of 11 EDs in Maryland. Using regression models, we compared each of the variables 18 months after the policy changes and a six-month washout period to the year prior to ACA/GBR implementation. We included the median income of each ED’s patient population as an explanatory variable and stratified our results by SES.

Results: Our 11 EDs saw an annualized volume of 399,310 patient visits during the study period. This ranged from a mean of 41 daily visits in the lowest volume rural ED to 171 in the highest volume suburban ED. After ACA/GBR, ED volumes were unchanged (95% confidence interval [CI] [−1.58–1.24], p=.817). Hospitalization percentages decreased significantly by 1.9% from 17.2% to 15.3% (95% CI [−2.47%–1.38%], p<.001). The percentage of uninsured patients decreased from 20.4% to 11.9%. This 8.5% change was significant (95% CI [−9.20%–7.80%], p<.001). The professional revenue per relative value unit increased significantly by $3.97 (95% CI [3.20–4.74], p<.001). When stratified by the median patient income of each ED, changes in each outcome were significantly more pronounced in EDs of lower SES.

Conclusion: Health policy changes at the federal and state levels have resulted in significant changes to emergency medicine practice and finances in MD. Admission and observation percentages have been reduced, fewer patients are uninsured, and professional revenue has increased. All changes are significantly more pronounced in EDs with patients of lower SES.

No MeSH data available.


Run chart of the percentage of uninsured patients from baseline year through study period.ACA, Affordable Care Act; GBR, global budget revenue.
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f3-wjem-18-356: Run chart of the percentage of uninsured patients from baseline year through study period.ACA, Affordable Care Act; GBR, global budget revenue.

Mentions: Our analysis of the percentage of uninsured ED patients before and after the implementation of the ACA/GBR is given in Figure 3 and Table 4s. The rate of uninsured patients decreased by a statistically significant 8.5 percentage points (95% CI [−9.20%, −7.80%], p<.001). Before implementation of the ACA, the average ED month had 20.4% uninsured patients. After implementation, the rate was 11.9%, a relative reduction of 42%. The percentage of patients covered by Medicaid increased by 8.5% (95% CI [7.7%, 9.2%], p<.001), the percentage covered by Medicare increased by 0.9% (95% CI [0.6%, 1.2%], p<.001), and the percentage with private insurance decreased by 1.9% (95% CI [−2.5%, −1.2%], p<.001).


Impact of Health Policy Changes on Emergency Medicine in Maryland Stratified by Socioeconomic Status
Run chart of the percentage of uninsured patients from baseline year through study period.ACA, Affordable Care Act; GBR, global budget revenue.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5391884&req=5

f3-wjem-18-356: Run chart of the percentage of uninsured patients from baseline year through study period.ACA, Affordable Care Act; GBR, global budget revenue.
Mentions: Our analysis of the percentage of uninsured ED patients before and after the implementation of the ACA/GBR is given in Figure 3 and Table 4s. The rate of uninsured patients decreased by a statistically significant 8.5 percentage points (95% CI [−9.20%, −7.80%], p<.001). Before implementation of the ACA, the average ED month had 20.4% uninsured patients. After implementation, the rate was 11.9%, a relative reduction of 42%. The percentage of patients covered by Medicaid increased by 8.5% (95% CI [7.7%, 9.2%], p<.001), the percentage covered by Medicare increased by 0.9% (95% CI [0.6%, 1.2%], p<.001), and the percentage with private insurance decreased by 1.9% (95% CI [−2.5%, −1.2%], p<.001).

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: On January 1, 2014, the financing and delivery of healthcare in the state of Maryland (MD) profoundly changed. The insurance provisions of the Patient Protection and Affordable Care Act (ACA) began implementation and a major revision of MD&rsquo;s Medicare waiver ushered in a Global Budget Revenue (GBR) structure for hospital reimbursement. Our objective was to analyze the impact of these policy changes on emergency department (ED) utilization, hospitalization practices, insurance profiles, and professional revenue. We stratified our analysis by the socioeconomic status (SES) of the ED patient population.

Methods: We collected monthly mean data including patient volume, hospitalization percentages, payer mix, and professional revenue from January 2013 through December 2015 from a convenience sample of 11 EDs in Maryland. Using regression models, we compared each of the variables 18 months after the policy changes and a six-month washout period to the year prior to ACA/GBR implementation. We included the median income of each ED&rsquo;s patient population as an explanatory variable and stratified our results by SES.

Results: Our 11 EDs saw an annualized volume of 399,310 patient visits during the study period. This ranged from a mean of 41 daily visits in the lowest volume rural ED to 171 in the highest volume suburban ED. After ACA/GBR, ED volumes were unchanged (95% confidence interval [CI] [&minus;1.58&ndash;1.24], p=.817). Hospitalization percentages decreased significantly by 1.9% from 17.2% to 15.3% (95% CI [&minus;2.47%&ndash;1.38%], p&lt;.001). The percentage of uninsured patients decreased from 20.4% to 11.9%. This 8.5% change was significant (95% CI [&minus;9.20%&ndash;7.80%], p&lt;.001). The professional revenue per relative value unit increased significantly by $3.97 (95% CI [3.20&ndash;4.74], p&lt;.001). When stratified by the median patient income of each ED, changes in each outcome were significantly more pronounced in EDs of lower SES.

Conclusion: Health policy changes at the federal and state levels have resulted in significant changes to emergency medicine practice and finances in MD. Admission and observation percentages have been reduced, fewer patients are uninsured, and professional revenue has increased. All changes are significantly more pronounced in EDs with patients of lower SES.

No MeSH data available.