Abstract
Objective
To determine how Medicaid expansion under the Affordable Care Act of 2010 (ACA) has
affected hospital pricing practices for surgical episodes of care.
Methods
Given that safety net hospitals would be more vulnerable to decreasing reimbursement
due to an increase in proportion of Medicaid patients, we utilized the Premier Healthcare
Database to compare institutional charge-to-cost ratio (CCR) in safety net hospitals
vs nonsafety net hospitals for 8 index urologic surgery procedures during the period
from 2012 to 2015. The effect of Medicaid expansion on CCR was assessed through difference-in-differences
analysis.
Results
CCR among safety net hospitals increased from 4.06 to 4.30 following ACA-related Medicaid
expansion. This did not significantly differ from the change among nonsafety net hospitals,
which was from 4.00 to 4.38 (P = .086). The census division with the highest degree of Medicaid expansion experienced
a smaller increase in CCR among safety net hospitals relative to nonsafety net (P < .0001). CCR increased by a greater degree in safety net hospitals compared to nonsafety
net in the census division where Medicaid expansion was the least prevalent (P < .0001).
Conclusion
Safety net hospitals have not preferentially increased CCR in response to ACA-related
Medicaid expansion. Census divisions where safety net hospitals did increase CCR more
than their nonsafety net counterparts do not correspond to those where Medicaid expansion
was most prevalent. This could indicate that, despite being more vulnerable to an
increased proportion of more poorly reimbursing Medicaid patients, safety net hospitals
have not reacted by increasing charges to private payers.
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Article info
Publication history
Published online: October 26, 2018
Accepted:
October 18,
2018
Received:
August 7,
2018
Footnotes
Financial Disclosures: The authors declare that they have no relevant financial interests.
Funding Support: None.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
