Journal article
Evaluation of US Hospital Episode Spending for Acute Inpatient Conditions After the Patient Protection and Affordable Care Act
JAMA network open, Vol.3(11), pp.e2023926-e2023926
11/02/2020
DOI: 10.1001/jamanetworkopen.2020.23926
PMCID: 7684450
PMID: 33226430
Abstract
Under the Patient Protection and Affordable Care Act (ACA), US hospitals were exposed to a number of reforms intended to reduce spending, many of which, beginning in 2012, targeted acute care hospitals and often focused on specific diagnoses (eg, acute myocardial infarction, heart failure, and pneumonia) for Medicare patients. Other provisions enacted in the ACA and under budget sequestration (beginning in 2013) mandated Medicare fee cuts.
To evaluate the association between the enactment of ACA reforms and 30-day price-standardized hospital episode spending.
This policy evaluation included index discharges between January 1, 2008, and August 31, 2015, from a national random 20% sample of Medicare beneficiaries. Data analysis was performed from February 1, 2019 to July 8, 2020.
Payment reforms after passage of the ACA.
30-day price-standardized episode payments. Three alternative estimation approaches were used to evaluate the association between reforms following the ACA and episode spending: (1) a difference-in-difference (DID) analysis among acute care hospitals, comparing spending for diagnoses commonly targeted by ACA programs with nontargeted diagnoses; (2) a DID analysis comparing acute care hospitals and critical access hospitals (not exposed to reforms); and (3) a generalized synthetic control analysis, comparing acute care and critical access hospitals. Supplemental analysis examined the degree to which Medicare fee cuts contributed to spending reductions.
A total of 7 634 242 index discharges (4 525 630 [59.2%] female patients; mean [SD] age, 79.31 [8.02] years) were included. All 3 approaches found that reforms following the ACA were associated with a significant reduction in episode spending. The DID estimate comparing targeted and untargeted diagnoses suggested that reforms following the ACA were associated with a -$431 (95% CI, -$492 to -$369; -2.87%) change in total spending, while the generalized synthetic control analysis suggested that reforms were associated with a -$1232 (95% CI, -$1488 to -$965; -10.12%) change in total episode spending, amounting in a total annual savings of $5.68 billion. Cuts to Medicare fees accounted for most of these savings.
In this policy evaluation, the ACA was associated with large reductions in US hospital episode spending.
Details
- Title: Subtitle
- Evaluation of US Hospital Episode Spending for Acute Inpatient Conditions After the Patient Protection and Affordable Care Act
- Creators
- Andrew M Ibrahim - University of MichiganUshapoorna Nuliyalu - University of MichiganEmily J Lawton - University of MichiganStephen O'Neil - Ollscoil na Gaillimhe – University of GalwayJustin B Dimick - University of MichiganBaris Gulseren - University of MichiganShashank S Sinha - University of MichiganJohn M Hollingsworth - University of MichiganTedi A Engler - University of MichiganAndrew M Ryan - University of Michigan
- Resource Type
- Journal article
- Publication Details
- JAMA network open, Vol.3(11), pp.e2023926-e2023926
- DOI
- 10.1001/jamanetworkopen.2020.23926
- PMID
- 33226430
- PMCID
- 7684450
- NLM abbreviation
- JAMA Netw Open
- ISSN
- 2574-3805
- eISSN
- 2574-3805
- Grant note
- R01 HS024728 / AHRQ HHS T32 HL007853 / NHLBI NIH HHS R01 AG039434 / NIA NIH HHS R01 AG047932 / NIA NIH HHS R01 HS024525 / AHRQ HHS
- Language
- English
- Date published
- 11/02/2020
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9984446271002771
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