Changes in the care of spine surgical patients following health reform in Massachusetts: A review of the literature

Blucher, Justin A.; Schoenfeld, Andrew J.

doi:10.1053/j.semss.2018.07.003

Seminars in Spine Surgery

2019

DOI: 10.1053/j.semss.2018.07.003

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Changes in the care of spine surgical patients following health reform in Massachusetts: A review of the literature

Justin A. Blucher

Andrew J. Schoenfeld

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2022

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“…Preliminary investigations that evaluated healthcare reform in Massachusetts yielded mixed results regarding the extent to which Medicaid expansion influenced spine surgery access and quality. 14 For example, one investigation found unchanged rates of surgical intervention for cervical spine fracture after health reform, but several markers of quality improved. 15 Given these limited and inconclusive results, focused attention is needed to identify the extent to which the ACA has impacted access to spine care, particularly elective surgical procedures where physicians may have more discretion in determining whether to offer a surgery on the basis of patient insurance status.…”

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Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care

Greenberg

Brown²,

Olsen

et al. 2022

Journal of Neurosurgery: Spine

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OBJECTIVE The Affordable Care Act expanded Medicaid eligibility in many states, improving access to some forms of elective healthcare in the United States. Whether this effort increased access to elective spine surgical care is unknown. This study’s objective was to evaluate the impact of Medicaid expansion under the Affordable Care Act on the volume and payer mix of elective spine surgery in the United States. METHODS This study evaluated elective spine surgical procedures performed from 2011 to 2016 and included in the all-payer State Inpatient Databases of 10 states that expanded Medicaid access in 2014, as well as 4 states that did not expand Medicaid access. Adult patients aged 18–64 years who underwent elective spine surgery were included. The authors used a quasi-experimental difference-in-difference design to evaluate the impact of Medicaid expansion on hospital procedure volume and payer mix, independent of time-dependent trends. Subgroup analysis was conducted that stratified results according to cervical fusion, thoracolumbar fusion, and noninstrumented surgery. RESULTS The authors identified 218,648 surgical procedures performed in 10 Medicaid expansion states and 118,693 procedures performed in 4 nonexpansion states. Medicaid expansion was associated with a 17% (95% CI 2%–35%, p = 0.03) increase in mean hospital spine surgical volume and a 23% (95% CI −0.3% to 52%, p = 0.054) increase in Medicaid volume. Privately insured surgical volumes did not change significantly (incidence rate ratio 1.13, 95% CI −5% to 34%, p = 0.18). The increase in Medicaid volume led to a shift in payer mix, with the proportion of Medicaid patients increasing by 6.0 percentage points (95% CI 4.1–7.0, p < 0.001) and the proportion of private payers decreasing by 6.7 percentage points (95% CI 4.5–8.8, p < 0.001). Although the magnitude of effects varied, these trends were similar across procedure subgroups. CONCLUSIONS Medicaid expansion under the Affordable Care Act was associated with an economically and statistically significant increase in spine surgery volume and the proportion of surgical patients with Medicaid insurance, indicating improved access to care.

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mentioning

confidence: 99%

Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care

Greenberg

Brown²,

Olsen

et al. 2022

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

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Changes in the care of spine surgical patients following health reform in Massachusetts: A review of the literature

Cited by 1 publication

References 22 publications

Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care

Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care

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