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dc.contributor.authorPimentel, L.
dc.contributor.authorAnderson, D.
dc.contributor.authorGolden, B.
dc.date.accessioned2019-07-15T16:12:12Z
dc.date.available2019-07-15T16:12:12Z
dc.date.issued2017
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85017582526&doi=10.5811%2fwestjem.2017.1.31778&partnerID=40&md5=28ebc0fdeb8795f9b5b7df5275be1738
dc.identifier.urihttp://hdl.handle.net/10713/9938
dc.description.abstractIntroduction: 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. Copyright 2017 Pimentel et al.en_US
dc.description.urihttps://www.doi.org/10.5811/westjem.2017.1.31778en_US
dc.language.isoen_USen_US
dc.publishereScholarshipen_US
dc.relation.ispartofWestern Journal of Emergency Medicine
dc.subjectAffordable care acten_US
dc.subjectEmergency medicineen_US
dc.subjectHealth policyen_US
dc.titleImpact of health policy changes on emergency medicine in Maryland stratified by socioeconomic statusen_US
dc.typeArticleen_US
dc.identifier.doi10.5811/westjem.2017.1.31778
dc.identifier.pmid28435485


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