Background: Kentucky had one of the nation’s largest increases in insurance coverage with the Affordable Care Act’s (ACA) Medicaid expansion, quadrupling the proportion of Kentuckians with insurance coverage. This study compares reimbursement rates for surgical procedures performed by emergency general surgery (EGS) services at the University of Kentucky (UK) before and after Medicaid expansion in January 2014. Methods: This IRB-approved, single-institution study retrospectively evaluated all patients undergoing surgical treatment by our EGS team from 1/1/2011 to 12/31/2016. We queried operative records for the most frequently performed procedures by the EGS service. We reviewed patient electronic medical records and hospital financial records to identify insurance status, diagnosis codes, and expected hospital reimbursements, based on UK Hospital’s procedure/payer accounting models. Results: Four thousand six hundred ninety-three patient procedures met inclusion criteria; 46.5% of these came before ACA expansion and 53.5% after expansion. The most frequent procedures performed were incision and drainage, laparoscopic appendectomy, laparoscopic cholecystectomy, and exploratory laparotomy. After ACA expansion, the proportion of patients with Medicaid nearly doubled (19.8% vs. 35.6%, p < 0.001). Concomitantly, there was a more than fivefold decrease in the uninsured patient population after expansion (23.3% vs. 4.6%, p < 0.001), and mean hospital reimbursement increased for laparoscopic appendectomy (13.7%, p < 0.001), laparoscopic cholecystectomy (50.7%, p < 0.001), and incision and drainage (70.2%, p < 0.001). Conclusion: After ACA expansion, there was a sustained decrease in proportion of uninsured patients and a concomitant sustained increase in proportion of patients with access to Medicaid services in the EGS operative population, leading to increased mean hospital reimbursements and decreased patient financial burden.
|Number of pages||6|
|Journal||Journal of Gastrointestinal Surgery|
|State||Published - Jan 2022|
Bibliographical noteFunding Information:
Dr. Bautista was supported by a National Institutes of Health (NIH), National Cancer Institute training grant (T32 CA160003): Oncology Research Training for Surgeon-Scientists. Dr. Madabhushi was supported by the University of Kentucky, Center for Clinical and Translational Science, TL1 Grant (NIH: TL1TR001997).
© 2021, The Society for Surgery of the Alimentary Tract.
- Affordable Care Act
- Emergency general surgery
- Medicaid expansion
ASJC Scopus subject areas