The Financial Impact of the Affordable Care Act on a Level-1 Orthopedic Trauma Service
The Financial Impact of the Affordable Care Act on a Level-1 Orthopedic Trauma Service
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DOI：
10.1097/bot.0000000000001374
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发表时间：
2019-03-01
影响因子：
2.3
通讯作者：
Wolinsky, Philip R.
中科院分区：
文献类型：
--
作者：
Beck, Chad J.;Shelton, Trevor J.;Wolinsky, Philip R.
目的：确定《平价医疗法案》(ACA)对一级创伤中心骨科创伤服务的专业费用和付费类型比例的影响。方法：我们分析了ACA实施前和实施后18个月的专业费用数据和付费类型。收集住院患者(IP)和门诊患者(OP)的数据。我们通过计算每个患者的平均值来校正两个时间段之间患者数量的变化。结果：ACA后，我们治疗了更高比例的医疗补助患者，而未参保/县支付者的比例减少了。每名患者的IP收集费减少了75.49美元，运营减少了0.10美元。我们的IP收款率下降了6%，OPS下降了5%。特别是，在ACA后，Medicaid收款减少了180美元/IP和4美元/OP，Medicare减少了61美元/IP和增加了5美元/OP，而合同收款增加了140美元/IP和20美元/OP。我们自己机构的保险的变化是混合的，部分风险保险减少了514美元/IP，完全风险保险减少了735美元/IP，部分风险保险增加了1美元/OP，完全风险保险增加了35美元/OP。这一转变伴随着我们收款率的显著下降；具体地说，我们对每个医疗补助患者收取的金额减少--这是ACA后增加的支付者类别。ACA确实允许更多未参保的患者获得医疗保健，但与较低的IP和OP报销有关。
Objectives: To determine the impact of the Affordable Care Act (ACA) on professional fees and proportion of payer type for an orthopedic trauma service at a level-1 trauma center.Methods: We analyzed professional fee data and payer mix for the 18 months before and after implementation of the ACA. Data were collected for inpatients (IP) and outpatients (OP). We corrected for changes in patient volume between the 2-time periods by calculating average values per patient.Results: Post ACA, we treated a higher percentage of patients with Medicaid and had a reduction in the percentage of uninsured/county payers. Collections for IPs decreased $ 75.49/patient and OPs decreased $ 0.10/patient. Our collection rate decreased 6% for IPs and 5% for OPs. In particular, Medicaid collections decreased by $ 180/IP, and $ 4/OP, and Medicare decreased by $ 61/IP and increased $ 5/OP post ACA, whereas contract collections increased by $ 140/IP and $ 20/OP. The changes in our own institution's insurance were mixed with decreases of $ 514/IP for partial risk and $ 735/ IP for full-risk insurance and increases of $ 1/OP for partial risk, and $ 35/OP for full-risk insurance.Conclusions: Post ACA, we saw less patients, primarily in the OP setting. This shift was accompanied by a significant decrease in our collection rate; specifically, a decrease in the amount we collected per Medicaid patient-the category of payer that increased post ACA. The ACA did allow more uninsured patients access to medical care but was associated with lower IP and OP reimbursements.