Medicaid expansion has not improved key hospital operations


Extension of Medicaid Compared with hospitals in non-expanding states, it has not made critical access hospitals financially more stable or better in terms of patient care.

A new study in the December issue of Health Affairs found that the quality scores or overall staffing levels of these hospitals did not improve compared to key access facilities in states without expanded insurance plans.

The study authors wrote: “These findings support the argument that although the expansion of Medicaid may be beneficial to some hospitals, it is not a panacea for all the challenges faced by hospitals that serve rural areas and underserved communities.”

Approximately one-third of US hospitals have been designated by the federal government as critical access, which means they have fewer than 25 beds and are more than 35 miles from the nearest hospital. Of the 1,158 critical access hospitals in the study, nearly 60% of the states where they are located have expanded Medicaid to more residents.

Studies have shown that there is not much difference between the amount of unpaid care provided by these two hospitals Medicaid state. They saw an overall increase in operating profit margin of only 1.3%, which the researchers believe is not significant.

“In theory, the increase in the number of insureds in the Medicaid program should push these hospitals to make more profits, or at least start to break even, but they must also have many very expensive technologies or services, which, frankly, does not really Get the use of Catalyst Health Care Consulting’s senior vice president of market access and reimbursement strategy, Jeff Myers, said that these independent factors may not be offset by the increase in Medicaid payments. Limited, this does not allow them to share these fixed costs among many people. “

The researchers also studied the Hospital Consumer Assessment (HCAHPS) of healthcare providers and systems, which measures patient satisfaction, heart failure, readmission rates for pneumonia, and mortality. Hospitals in states with expanded Medicaid have almost the same scores on all indicators as hospitals without expanded Medicaid. Leah Binder, president of The Leapfrog Group, a non-profit organization, said that improvements in these areas are usually driven by more direct efforts by payers and hospital leaders to improve quality, not just to get more insured patients. .

“To truly improve quality and safety, hospitals need strong leadership focused on quality, coupled with the enthusiasm to ensure patient safety and put patients first; if Medicaid or other funds reward such excellence, we Will see real improvements in the quality of those care. Hospitals provide,” Binder said, but added that more attention needs to be paid to the quality and safety of key visits to hospitals, which are usually not subject to national measurement plans.

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The study authors also believe that critical access hospitals generally provide care for patients who do not have access to primary care and communities where the social determinants of health challenges are greater.

Congress currently consider this Rebuild better actionsThis will increase Medicaid and extend the coverage of similar Medicaid to low-income residents in states that choose not to expand Medicaid. However, the hospital group expressed concern that this would not necessarily benefit hospitals in the remaining 12 states without expansion.

The key access hospital data comes from the health care provider cost report information system of the Medicare and Medicaid Service Center from 2011 to 2018.

other Learn Studies that looked at the impact of expansion on hospitals found overall financial benefits, but did not just focus on key access hospitals.



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