Emergency Department Use in a U.S. Health Care System Before and After Implementation of the Coverage Provisions of the Affordable Care Act

OBJECTIVESeveral similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors’ prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US.METHODSUsing the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers’ compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control.RESULTSThe authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and “other” categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65–84 years old, with a decrease in surgeries for those 18–44 years old. New York showed an increase in all insurance categories and all adult age groups.CONCLUSIONSAfter the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly population. The Massachusetts model continues to show that this type of policy is not causing extreme shifts in the payer mix, and suggests that spine surgery will continue to thrive in the current US health care system.

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The emergency department — Entry point into the health care system

Journal of the American College of Emergency Physicians ◽

10.1016/s0361-1124(75)80144-4 ◽

1975 ◽

Vol 4 (2) ◽

pp. 129-132 ◽

Cited By ~ 4

Author(s):

Lynn L. Walker

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care System ◽

Entry Point ◽

Care System

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The Affordable Care Act and emergency department use by low acuity patients in a US hospital

Health Services Management Research ◽

10.1177/0951484820943599 ◽

2020 ◽

pp. 095148482094359

Author(s):

Daniel Keyes ◽

Hisham Valiuddin ◽

Hassan Mouzaihem ◽

Patrick Stone ◽

Jaqueline Vidosh

Keyword(s):

Emergency Department ◽

Affordable Care Act ◽

Cohort Analysis ◽

Severity Index ◽

Chi Square ◽

Before And After ◽

Primary Care Patients ◽

Ed Visits ◽

The Affordable Care Act ◽

Status Data

Background The Affordable Care Act (ACA) is one of the biggest healthcare reforms in US history. A key issue is the ACAs effect on low acuity, potentially primary care patients. This study evaluates the effect of the ACA on low acuity patients seen in the emergency department (ED). Methods This is an age-period-cohort analysis for a community hospital ED in Michigan, from 2009 to 2015. Patients were stratified by age, year seen, emergency severity index (ESI) and insurance status. Data were compared between before and after ACA along with descriptive statistics, Chi-square and Student t-tests. The primary outcome was the change in ED usage by low acuity. Patients > 65 were used as a temporal control. Results 305,350 ED visits were analyzed. ED visits with ESI 4/5 increased from 11.9% to 14.8%. Patients < 19 years increased from 25.5% to 34.3% (p = .0026). Ages 19–25 increased from 16.3% to 19.7% (p = 0.0515). Ages 26–64 increased from 11% to 14.9% (p = 0.0129). Ages > 65 increased from 5.1% to 6.5%. Patients < 65 showed a decreased uninsured rate from 12.30% to 6.28% (p < 0.0001). Comparatively, for age > 65: uninsured rate remained the same 0.46% to 0.49%. Conclusion Low acuity ED visits increased with the ACA reform in conjunction with a more insured population.

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US Emergency Department Visits and Hospital Discharges Among Uninsured Patients Before and After Implementation of the Affordable Care Act

JAMA Network Open ◽

10.1001/jamanetworkopen.2019.2662 ◽

2019 ◽

Vol 2 (4) ◽

pp. e192662 ◽

Cited By ~ 14

Author(s):

Adam J. Singer ◽

Henry C. Thode ◽

Jesse M. Pines

Keyword(s):

Emergency Department ◽

Affordable Care Act ◽

Emergency Department Visits ◽

Hospital Discharges ◽

Uninsured Patients ◽

Before And After ◽

The Affordable Care Act

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P1546UK ANNUAL THERAPY COST OF DIALYSIS WITH THE QUANTA SC+ PERSONAL HAEMODIALYSIS SYSTEM

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1546 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Thomas Ferguson ◽

Paul Komenda ◽

Gerard Harper ◽

John Milad

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care System ◽

Self Care ◽

Emergency Department Visits ◽

Weekend Effect ◽

Care At Home ◽

The Uk ◽

Care System ◽

At Home

Abstract Background and Aims The number of patients receiving dialysis is increasing in the United Kingdom, costing the National Health Service (NHS) over 500 million GBP annually. New personal haemodialysis systems are being developed, such as the Quanta SC+, that are smaller and simpler to use by patients while providing the clearances of conventional systems. Increasing uptake of lower intensity assistance and full self-care dialysis may provide economic benefits to the public health payer. In addition, promotion of every other day dialysis (3.5x weekly) may improve costs to the health system by helping to close the “post-weekend effect” with increased emergency department use and hospitalisations following the long interdialytic gap. As such, we aimed to describe the annual therapy costs of using SC+ in the UK for 3x weekly and 3.5x weekly dialysis regimens, both for self-care haemodialysis provided in-centre and at home in comparison to dialysis provided with conventional machines from the perspective of the health care system. Method Cost minimisation approach. Costs for human resources, equipment, and consumables were sourced from the dialysis machine developer (Quanta Dialysis Technologies). Other costs, such as facility expenses, dialysis-related drugs, avoided emergency department and hospitalisation events, and utilities were taken from a review of the literature. Costs are provided in 2018 GBP. Results Therapy provided as self-care in-centre or full self-care at home were found to have similar costs (£33,721 in-centre versus £33,836 at home for the 3x weekly regimen). Costs increased to £37,238 for self-care in-centre and £35,557 at home for the 3.5x weekly regimen. A comparator cost of £39,416 was established for dialysis provided with conventional machines in-hospital 3x weekly. For each dialysis patient, the health care system is anticipated to save £3,666 in costs associated with excess hospital stays and £2,176 in costs associated with excess emergency department visits. Conclusion In the UK, SC+ offers cost savings when used both for self-care in-centre and full self-care at home in comparison to dialysis provided in the clinic using conventional machines.

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