J. Holzmacher1, K. Townsend1, C. Seavey1, S. Gannon1, L. Collins1, R. L. Amdur1, B. Sarani1 1George Washington University School Of Medicine And Health Sciences,Surgery,Washington, DC, USA
Introduction:
Despite implementation of the Affordable Care Act (ACA), states differ regarding specific eligibility requirements, coverage, and benefits. Washington DC (DC) has the most expansive Medicaid eligibility, including coverage for undocumented immigrants and individuals at a higher federal poverty income threshold, followed by Maryland (MD), which meets ACA expansion standards, and Virginia (VA), which has not expanded Medicaid. We hypothesize that patients in DC have a shorter hospital length of stay (LOS) following injury than either MD or VA.
Methods:
A retrospective study of an adult, urban trauma center, which receives patients from DC, VA, and MD, was performed from 2013-2016. Private insurance was excluded. A multivariate linear model predicting LOS by insurance and state and a model examining LOS by insurance type within states were created after adjusting for demographics, injury severity, penetrating injury, and head and pelvis abbreviated injury scores.
Results:
2728 patients were enrolled. Average patient age and injury severity scores were 53 ± 23 years old and 7 ± 6, respectively . 90% of patients sustained a blunt mechanism of injury. Overall, 36% of patients had Medicaid and 42% had Medicare insurance. 20% of the overall cohort was uninsured. 47% of patients in DC had Medicaid compared with 18% in MD and 8% in VA (p<0.0001). 39% of patients in DC had Medicare compared with 47% in MD and 43% in VA (p<0.0001).
Adjusted LOS was 1.9 days shorter for Medicaid patients in DC versus VA (p=0.003), and 0.9 days shorter in DC versus MD (p=0.02) (figure 1). Uninsured patients had 0.7 and 2.4 days shorter LOS than Medicaid in DC (p<0.0001) and VA (p=0.006), respectively, but no difference in LOS was found between states. Medicaid patients had 0.5 days shorter LOS than Medicare patients in DC (p=0.017), but 1.9 days longer LOS than Medicare patients in VA (p=0.042). There was no difference in LOS between Medicare and Medicaid patients in MD.
Conclusion:
Expanded Medicaid coverage, which includes undocumented immigrants and individuals at a higher federal poverty income threshold, is associated with shorter LOS following injury.
