J. Claflin1, J. B. Dimick1, D. A. Campbell1, M. J. Englesbe1, K. H. Sheetz1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA
Introduction:
Few studies have evaluated whether poor outcomes for Medicaid beneficiaries are driven by patients’ choice in hospitals. We sought to evaluate the associations between hospital choice and surgical outcomes in Medicaid patients.
Methods:
We identified 139,566 non-elderly Medicaid and private insurance beneficiaries undergoing general, vascular, or gynecological surgery between 2012-17 using a statewide clinical registry in Michigan, a Medicaid expansion state. We calculated risk-adjusted rates of complications, readmissions, emergency department (ED) visits, and post-acute care utilization using multivariable logistic regression, accounting for patient and procedural factors. We then evaluated if, and to what extent, the choice of hospital influenced outcome disparities between Medicaid and private insurance beneficiaries.
Results:
Adjusted rates for all outcomes were higher in Medicaid patients. For example, 14.7% of Medicaid patients returned to the ED after discharge compared to 7.5% for private insurance patients (P<0.01). Hospital choice explained <1.0% of the observed difference in complication rates between Medicaid and private insurance patients. In contrast, hospital choice explained a significant proportion of the disparities in readmissions (29.7%), ED visits (15.2%), and post-acute care utilization (41.2%). While differences in outcomes were similar, hospitals’ Medicaid populations changed by -39.9% to +460.0% before and after Medicaid expansion.
Conclusion:
Hospital choice accounts for a significant proportion of the disparities in post-discharge resource utilization between Medicaid and privately insured patients. Policies aiming to improve the quality and equity of surgical care for Medicaid beneficiaries should focus on the post-acute care period.
