MP76-06 THE EFFECT OF AFFORDABLE CARE ACT-RELATED MEDICAID EXPANSION ON UTILIZATION OF UROLOGIC SURGICAL SERVICES

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost & Outcomes Measures I1 Apr 2018MP76-06 THE EFFECT OF AFFORDABLE CARE ACT-RELATED MEDICAID EXPANSION ON UTILIZATION OF UROLOGIC SURGICAL SERVICES Tyler R. McClintock, Alexander P. Cole, Ye Wang, Daniel Pucheril, Sebastian Berg, Steven L. Chang, Adam S. Kibel, and Quoc-Dien Trinh Tyler R. McClintockTyler R. McClintock More articles by this author , Alexander P. ColeAlexander P. Cole More articles by this author , Ye WangYe Wang More articles by this author , Daniel PucherilDaniel Pucheril More articles by this author , Sebastian BergSebastian Berg More articles by this author , Steven L. ChangSteven L. Chang More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2574AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Patient Protection and Affordable Care Act of 2010 sought to expand Medicaid coverage to all US adults 18-64 years of age whose income falls below 138% of the federal poverty line (approximately $16,642 USD/year). Because this policy was not implemented in all US states, we sought to compare state-level patterns of care and assess the effect of this insurance expansion on patterns of urologic care. We hypothesized that trends in urologic surgical procedures would differ in states that implemented Medicaid expansion compared to those that did not. METHODS Data from the State Information Database (SID) were abstracted between January 1, 2012 and December 31, 2014, representing information on discharges collected via federal-state partnerships as part of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. We chose Florida and New York databases for our analysis, as they represent one Medicaid expansion (New York) and one non-expansion (Florida) state among the top five most populated states. We identified all cases of the following procedures: transurethral resection of the prostate, radical cystectomy, nephrectomy or partial nephrectomy, and radical prostatectomy. Surgical utilization prior to expansion was compared to the period following Medicaid expansion, with 2013 serving as a washout period as newly qualifying individuals were enrolled in advance of January 2014 coverage eligibility. RESULTS There was a decline in overall surgical utilization in both states from 2012 to 2014, though to a lesser degree in New York compared to Florida (-5.83 versus -6.45 cases per 100,000, respectively; difference in differences = 0; p<0.0001). Additionally, Medicaid expansion had a small but statistically significant impact on payer composition, as percent of urologic surgery patients covered by Medicaid increased from 3.22% to 3.64% in Florida versus 7.11% to 8.92% in New York (multivariable adjusted difference in differences = 0.02%, p<0.0001). CONCLUSIONS Trends in utilization of urologic surgery from 2012-2014 differed in a small but statistically significantly degree on the basis of Medicaid expansion in this two-state comparison. Specifically, expansion was associated with a lesser degree of decline in surgical volume. While there was also an associated small increase in proportion of Medicaid-insured patients at the time of surgery, this is unlikely to be of practical consequence. Overall, expansion of Medicaid coverage has had a modest impact on rates of urologic surgical care at this early point of assessment. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1020 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Tyler R. McClintock More articles by this author Alexander P. Cole More articles by this author Ye Wang More articles by this author Daniel Pucheril More articles by this author Sebastian Berg More articles by this author Steven L. Chang More articles by this author Adam S. Kibel More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...