ArticleThe journal of trauma and acute care surgery2017
Potential impact of Affordable Care Act-related insurance expansion on trauma care reimbursement.
Article in The journal of trauma and acute care surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Emergency Medicaid enrollment after traumatic injury predicts long-term health care utilization.The journal of trauma and acute care surgery · 2025Article
- Unveiling the economic value of equitable care for the traumatically injured: is it cost-effective to decrease trauma disparities?Trauma surgery & acute care open · 2025Review
- Changes in payer mix of new and established trauma centers: the new trauma center money grab?Trauma surgery & acute care open · 2024Article
- The Affordable Care Act and its Effects on Trauma Care Access, Short- and Long-term Outcomes and Financial Impact: A Review Article.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2022Review
- Cost Barriers to Health Services in U.S. Adults Before and After the Implementation of the Affordable Care Act.Cureus · 2022Article
- Article
- Impact of the Affordable Care Act Medicaid Expansion on Reimbursement in Emergency General Surgery.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2022Article
- Impact of the affordable care act's medicaid expansion on burn outcomes and disposition.Burns : journal of the International Society for Burn Injuries · 2021Article
- Trauma center funding: time for an update.Trauma surgery & acute care open · 2021Article
- Describing the density of high-level trauma centers in the 15 largest US cities.Trauma surgery & acute care open · 2020Article
- Article
- The Dedicated Orthopaedic Trauma Room Model: Adopting a New Standard of Care.The Journal of bone and joint surgery. American volume · 2019Article
- Association of Medicaid Expansion With Access to Rehabilitative Care in Adult Trauma Patients.JAMA surgery · 2019Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
backgroundNearly 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.
methodsWe abstracted nonelderly adults (ages 18-64 years) admitted for trauma from the Nationwide Inpatient Sample during 2010-the last year before most major ACA coverage expansion policies. We calculated national and facility-level reimbursements and trauma-related contribution margins using Nationwide Inpatient Sample-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.
resultsThere were 145,849 patients (representing 737,852 patients nationwide) included. National inpatient trauma costs for patients aged 18 years to 64 years totaled US $14.8 billion (95% confidence interval [CI], 12.5,17.1). Preexpansion reimbursements totaled US $13.7 billion (95% CI, 10.8-14.7), yielding a national margin of -7.9% (95% CI, -10.6 to -5.1). Postexpansion projected reimbursements totaled US $15.0 billion (95% CI, 12.7-17.3), increasing the margin by 9.3 absolute percentage points to +1.4% (95% CI, -0.3 to +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 postexpansion projections. Those facilities with the highest proportion of uninsured and racial/ethnic minorities experienced the greatest gains.
conclusionHealth 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: Economic analysis, level II.
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