W. D. Hendricks2, A. B. Gibson2, K. Arnow2, C. Sheckter1, K. S. Romanowski3, L. M. Knowlton1,2 1Stanford University, Department Of Surgery, Palo Alto, CA, USA 2Stanford-Surgery Policy Improvement Research and Education Center, Palo Alto, CA, USA 3University Of California – Davis, Department Of Surgery, Sacramento, CA, USA
Introduction: Burn patients are at risk for complex hospitalizations and long-term physical, psychological and financial disability. More than 15% of burn patients remain uninsured, with limited access to post-discharge resources. Hospital Presumptive Eligibility (HPE) is a temporary insurance available at hospitalization, which can offset costs, increase access, and provide a path to sustaining long-term coverage through Medicaid. HPE has helped increase insurance coverage among trauma patients, but little is known regarding its success among burn patients. We aimed to determine Medicaid insurance status six months after burn injury and identify factors associated with successful sustainment.
Methods: We developed a customized longitudinal claims dataset for HPE-approved patients with the California Department of Health Care Services (DHCS). We analyzed adults admitted with a burn diagnosis (ICD-10) who were HPE approved in 2016 and 2017. Our primary outcome was Medicaid sustainment six months after HPE approval. Unadjusted and multivariate analyses were performed.
Results: We analyzed 455 HPE-approved burn inpatients, of which 333 (73.2%) sustained Medicaid at six months. 387 burn patients had concurrent traumatic injury, 219 (56%) of whom had an injury severity score (ISS) greater than 15. Compared to burn patients who did not sustain, those who sustained were more often English speaking (75.7%, vs. 59.8%, p<0.001), of either White (34.8% vs. 12.3%, p<0.001) or Hispanic ethnicity (41.1% vs. 14.8%, p<0.001) and had longer lengths of stay (LOS) (>7 days: 61.3% vs. 39.3%, p<0.001). Medicaid sustainment by percent total body surface area (% TBSA) is described in Figure 1. In adjusted analyses, long LOS (>7day: aOR 3.13, p=0.019) was associated with increased likelihood of Medicaid sustainment.
Conclusion: HPE programs can help burn inpatients acquire and sustain insurance coverage after their injury. Patients who have complex burns and prolonged hospitalizations are especially likely to benefit and sustain Medicaid after hospital discharge.
