Higher Hospitalization Costs and Fewer Routine Discharges in the Medicaid Expansion Era for Lung Transplant Recipients.

Autor: Kalra A; Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Ruck JM; Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Zhou AL; Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Akbar AF; Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Leng A; Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., You B; The Johns Hopkins Surgery Center for Outcomes Research (JSCOR), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Casillan AJ; Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Ha JS; Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Merlo CA; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Bush EL; Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2024 Nov; Vol. 38 (11), pp. e70017.
DOI: 10.1111/ctr.70017
Abstrakt: Background: In January 2014, states expanded Medicaid access under the Affordable Care Act. We studied the financial implications of this policy on lung transplantation, a costly procedure.
Methods: Lung transplant (LT) hospitalizations were identified within the National Inpatient Sample (2005-2020). Recipients were categorized as "pre-expansion" (1/2005-12/2013) versus "post-expansion" (1/2014-12/2020) of Medicaid and as being in "expander" versus "non-expander" regions. We calculated difference-in-differences estimates comparing pre- and post-expansion eras in expander versus non-expander regions for inflation-adjusted hospitalization costs and for discharge disposition. We evaluated total hospitalization costs using multivariable generalized linear regression, adjusting for recipient demographics, Charlson Comorbidity Index, single versus double-lung transplant, and extracorporeal membrane oxygenation (ECMO), ex-vivo lung perfusion (EVLP), and mechanical ventilation usage.
Results: Of the 29 225 LT recipients identified, 14 085 were pre-expansion and 15 140 were post-expansion. More recipients were insured by Medicaid in expander n = 735 (9%) versus non-expander n = 220, (3%) regions (p = 0.01) post-expansion. Hospitalization costs increased post- versus pre-expansion by $20 948 (95% CI = $8713-$33 183, p < 0.001) more in expander versus non-expander regions even after adjustment for risk factors associated with increased costs. Within expander regions, recipients post- versus pre-expansion were less likely to be discharged routinely (n = 2625, 28% vs. n = 3959, 44%) and more likely to be discharged to care facilities (n = 2045, 22% vs. n = 1045, 12%, p < 0.001).
Conclusions: Although Medicaid expansion resulted in greater access to care, it was associated with increased hospitalization costs and fewer routine discharges for LT recipients. Further research is warranted to identify the reasons that underpin the financial sequelae of Medicaid expansion, including changes in access to care for sicker patients.
(© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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