A. Y. Williams1, S. N. Davis1, S. K. Hill1, P. Connor1, Y. Lee1, C. C. Butts1, J. Simmons1, S. Brevard1, L. Ding1 1University Of South Alabama Medical Center,Department Of Trauma, Surgical Critical Care And Burn Surgery,Mobile, AL, USA
Introduction: The state of Alabama is one of 19 states opting out of Medicaid expansion under the Affordable Care Act. Many injured patients require post-hospital discharge specialty services and it has been demonstrated that the uninsured have less access to such services and are more likely to be discharged directly to home. Previous studies in Medicaid-expanded states have demonstrated up to a 20% decrease in the uninsured trauma population. The purpose of this study was to evaluate our trauma population payer mix before and after the implementation of the ACA and its effect on disposition.
Methods: This was a retrospective review of adult trauma patients treated at a level I trauma center with a large rural catchment area between 2011-2012 (pre-ACA) and 2014-2015 (post-ACA). Demographics, payer status, patient outcomes and disposition were recorded.
Results: We identified 3716 patients in the pre-ACA period and 3657 patients in the post-ACA period. Patients in the post-ACA period were more likely to be insured (59.37% vs 55.14%, p<0.001) and utilize post-discharge services (13.48% vs. 9.28%, p<0.001) when compared to the pre-ACA period. Medicaid patients are more likely than uninsured patients to receive home health services (OR 6.24, CI 2.74-14.18) or intermediate nursing care (OR 16.88, CI 7.05-40.43).
Conclusion: After the implementation of the ACA, our trauma center experienced a statistically significant decrease in the overall number of uninsured trauma patients with increased utilization of extended services after discharge. However, in our state without Medicaid expansion, this still leaves 40% of our patient population without health insurance.