The impact of the affordable care act on surgeon selection amongst colorectal surgery patients

Abstract

BackgroundIt is unclear how the Affordable Care Act’s state-based Medicaid Expansion (ME) has impacted surgeon selection for colorectal resections (CRS). MethodsWe performed a risk-adjusted DID analysis on state discharge data of CRS patients aged 26–64 from NY (Expansion) and FL (non-Expansion) before (2012–2013) and after (2016–2017) ME. Primary outcome was use of a high-volume or colorectal-boarded surgeon. Subset analysis performed on insurance status. ResultsAmong 78,866 CRS patients, ME was associated with a 5.9% increase in Medicaid enrollment. ME was associated with a 0.73 (95%CI: 0.67–0.69; p < 0.001) reduced odds of high-volume surgeon usage by commercially insured patients when compared to usage by commercially insured patients in the non-expansion state. No statistically significant difference was noted in the use of a colorectal-boarded surgeon following reform. ConclusionsME was associated with an increase in Medicaid enrollment and a decrease in the use of high-volume surgeons by the commercially insured.