Potential impact of ACA-related insurance expansion on trauma care reimbursement.

Introduction: Nearly one-quarter of trauma patients are uninsured and hospitals recoup less than 20% of inpatient costs for their care. This study examines changes to hospital reimbursement for inpatient trauma care if the full coverage expansion provisions of the Affordable Care Act (ACA) were in effect. Methods: We abstracted nonelderly adults (ages 18-64y) admitted for trauma from the Nationwide Inpatient Sample (NIS) during 2010-the last year prior to most major ACA coverage expansion policies. We calculated national and facility-level reimbursements and trauma-related contribution margins using NIS-supplied cost-to-charge ratios and published reimbursement rates for each payer type. Using US census data, we developed a probabilistic microsimulation model to determine the proportion of pre-ACA uninsured trauma patients that would be expected to gain private insurance, Medicaid, or remain uninsured after full implementation of the ACA. We then estimated the impact of these coverage changes on national and facility-level trauma reimbursement for this population. Results: 145,849 patients (representing 737,852 patients nationwide) were included. National inpatient trauma costs for 18-64y patients totaled $14.8 billion (95%CI:12.5,17.1). Pre-expansion reimbursements totaled $13.7 billion (10.8,14.7), yielding a national margin of -7.9% (-10.6,-5.1). Post-expansion projected reimbursements totaled $15.0 billion (12.7,17.3), increasing the margin by 9.3 absolute percentage-points to +1.4% (-0.3,+3.2). Of the 263 eligible facilities, 90 (34.2%) had a positive trauma-related contribution margin in 2010, which increased to 171 (65.0%) using post-expansion projections. Those facilities with the highest proportion of uninsured and racial/ethnic minorities experienced the greatest gains. Conclusion: Health insurance coverage expansion for uninsured trauma patients has the potential to increase national reimbursement for inpatient trauma care by over one billion dollars and nearly double the proportion of hospitals with a positive margin for trauma care. These data suggest that insurance coverage expansion has the potential to improve trauma centers' financial viability and their ability to provide care for their communities. Level of Evidence: - Level II: Sensible costs and alternatives; values obtained from limited sources; multi-way sensitivity analyses Study Type: - Policy Analysis/Economic Analysis (C) 2017 Lippincott Williams & Wilkins, Inc.

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