Higher Hospitalization Costs and Fewer Routine Discharges in the Medicaid Expansion Era for Lung Transplant Recipients
Fuente:
Wiley Open Access
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Artículo Open Access |
| Published: |
Wiley
2024
|
| Subjects: | |
| Online Access: | |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1867007945426862080 |
|---|---|
| author | Andrew Kalra Jessica M. Ruck Alice L. Zhou Armaan F. Akbar Albert Leng Bin You Alfred J. Casillan Jinny S. Ha Christian A. Merlo Errol L. Bush |
| author_facet | Andrew Kalra Jessica M. Ruck Alice L. Zhou Armaan F. Akbar Albert Leng Bin You Alfred J. Casillan Jinny S. Ha Christian A. Merlo Errol L. Bush Andrew Kalra Jessica M. Ruck Alice L. Zhou Armaan F. Akbar Albert Leng Bin You Alfred J. Casillan Jinny S. Ha Christian A. Merlo Errol L. Bush |
| collection | Wiley Open Access |
| contents | Higher Hospitalization Costs and Fewer Routine Discharges in the Medicaid Expansion Era for Lung Transplant Recipients Andrew Kalra Jessica M. Ruck Alice L. Zhou Armaan F. Akbar Albert Leng Bin You Alfred J. Casillan Jinny S. Ha Christian A. Merlo Errol L. Bush Clinical Transplantation ABSTRACTBackgroundIn 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.MethodsLung 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.ResultsOf 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).ConclusionsAlthough 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. 10.1111/ctr.70017 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/ctr.70017 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70017 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2024 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Higher Hospitalization Costs and Fewer Routine Discharges in the Medicaid Expansion Era for Lung Transplant Recipients Andrew Kalra Jessica M. Ruck Alice L. Zhou Armaan F. Akbar Albert Leng Bin You Alfred J. Casillan Jinny S. Ha Christian A. Merlo Errol L. Bush Clinical Transplantation Higher Hospitalization Costs and Fewer Routine Discharges in the Medicaid Expansion Era for Lung Transplant Recipients Andrew Kalra Jessica M. Ruck Alice L. Zhou Armaan F. Akbar Albert Leng Bin You Alfred J. Casillan Jinny S. Ha Christian A. Merlo Errol L. Bush Clinical Transplantation ABSTRACTBackgroundIn 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.MethodsLung 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.ResultsOf 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).ConclusionsAlthough 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. 10.1111/ctr.70017 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Higher Hospitalization Costs and Fewer Routine Discharges in the Medicaid Expansion Era for Lung Transplant Recipients |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70017 |