Initial impact of the affordable care act on an Ohio level 1 trauma center.

Introduction: Hospital financial pressures and inadequate reimbursement contribute to the closure of trauma centers. Uninsured patients contribute significantly to the burden of trauma center costs. The Affordable Care Act implemented changes in 2014 to provide health care coverage for all Americans. This study analyzes the impact of the recent health care changes on an Ohio Level 1 trauma center financials. Methods: We conducted an analysis of trauma charges, reimbursement, and supplemental payments at an Ohio Level 1 trauma center. A three-year trauma patient cohort (2012-2014) was selected and grouped by reimbursement source (Medicare, Medicaid, other government, commercial, and self-pay/charity). A total of 9,655 patients were reviewed. Data were collected with the Transition Systems Inc. accounting system and analyzed with IBM SPSS Statistics 22.0. Results: For trauma cases the percent of self-pay/charity patients decreased during the 2012-2014 period (15.1%, 15%, to 6.4%, respectively) while the percent of Medicaid decreased from 2012 to 2013 followed by a large increase in 2014 (15.4%, 13.9% to 24.3%, respectively). The percent of commercially insured patients decreased slightly from 2012 to 2014 (34.2%, 32.3% to 30.7%). Uninsured charges decreased notably (approximately $22.5M and 21M for 2012-13 to approximately $8.6M in 2014). Medicaid charges decreased from 2012 to 2013, followed by a rebound in 2014 ($50.7M in 2012 to $37.3M in 2013 to $54.3M in 2014). The percent of total charges for self-pay/charity decreased (9.5%, 10.1% to 4.1%). The percent of total charges for Medicaid increased (21.4%, 18.0% to 25.9%). Mean Medicaid reimbursement per patient decreased ($19,000, $14,000 to $13,000). Mean reimbursement per uninsured patient did not vary significantly among years. Total hospital supplemental payments (trauma and non-trauma combined) decreased ($47.6M, $49M to $39.2M). Conclusions: In the first year following the changes implemented by the ACA, our hospital saw self-pay/charity charges decrease, Medicaid charges increase, and total hospital supplemental payments decrease. Also, there was a small, yet noteworthy, downward trend in the number of commercially insured patients. Although more data collection and analysis are needed, this initial financial evaluation of a Level 1 trauma center following the Affordable Care Act provides insight into insurance trends. (C) 2016 Lippincott Williams & Wilkins, Inc.

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