Home E-Weekly May 20, 2014

Medicaid Expansion Could Jeopardize Hospital Finances

Published: May 19, 2014

A new study in JAMA Surgery suggests that it will cost hospitals more to care for sicker Medicaid patients at a time when the federal program is set to expand in more than half of the nation's states.

In a comparison of nearly 12,000 privately insured patients aged 18 to 64 and more than 2,000 Medicaid insured non-elderly patients who underwent inpatient general surgery at 52 Michigan hospitals over the course of a year, the Medicaid beneficiaries were twice as likely to have such health issues as hypertension, diabetes and COPD before surgery; suffered two-thirds more post-op complications and used 50% more hospital resources.

Hospitals who care for a large volume of Medicaid patients should pay particular attention to the findings, say the researchers, who were surprised that less than half of the hospitals included in the study cared for more than 61% of the low-income patients. They point out that 26 states have used the Affordable Care Act to expand Medicaid programs, which increases the possibility that the growing number of beneficiaries will decide to undergo surgery just as federal subsidy payments to cover the cost of caring for these patients are set to decline in the coming years.

"If we make the presumption that the new Medicaid-covered patients will fit the mold of what we see now, surgical and inpatient teams must be prepared to provide the care and support they need," says Seth Waits, MD, a surgical resident at the University of Michigan Medical School, who led the analysis. "Financially, it may be a double whammy for hospitals, especially those that have the highest percentage of their surgical population covered by Medicaid."

Daniel Cook

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