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Expanding Medicaid increases access to subspecialty procedures: researchers

By Andis Robeznieks
Posted: May 8, 2014 - 1:30 pm ET

Expanding Medicaid opens patient access to surgical-subspecialty procedures, according to University of Michigan researchers who studied how the proportion of Medicaid patients having certain operations increased 7.2% in New York after Medicaid coverage was expanded there in 2001.

Twenty-six states have expanded Medicaid under the Patient Protection and Affordable Care Act. New York had expanded Medicaid coverage Oct. 1, 2001, to include parents of dependent children with incomes up to 150% of the federal poverty level and for childless, nonelderly, nondisabled adults earning up to 100% of the poverty level.

Dr. Aviram Giladi, a University of Michigan plastic surgery resident, and colleagues examined the records of 185,526 adults between ages 19 and 64 who underwent one of three surgical procedures between 1998 and 2006. The study in a Journal of the American College of Surgeons was funded by the National Institutes of Health and the Plastic Surgery Foundation.

After expansion, the proportion of beneficiaries receiving these procedures increased 7.2%, or by an additional 1.9 Medicaid cases per quarter per 100,000 state residents. The procedures studied included leg “trauma management” (including reconstruction or amputation), breast cancer reconstruction and panniculectomy, a procedure to remove excess skin and tissue after significant weight loss. These procedures were chosen because they are associated with a hospital stay and they each have a unique referral pattern.

“When you see the effect that expanding Medicaid can have on patient access to needed care, the data suggest continuing to support Medicaid expansion in states that are in need,” Giladi said in a release.

There was no statistically significant corresponding decrease in these procedures for uninsured patients. But the proportion of Medicaid patients having breast cancer reconstruction increased 5.5% compared with pre-expansion projections. Similarly, the proportion of Medicaid patients having a panniculectomy increased 2.5% compared with the pre-expansion trajectory.

There was a statistically insignificant increase in leg trauma management. This was likely due to how these patients may already have had coverage by some type of auto or accident insurance, researchers said.

“This indicates that after Medicaid expansion, there was an overall increase in delivery of subspecialty surgical care to the underserved (uninsured and Medicaid),” Giladi and colleagues wrote. “Subspecialty surgeons responded to the influx of Medicaid beneficiaries by increasing services to these newly insured patients.”

Of the patients studied, 68,730 had the procedures done before the state's Medicaid expansion, and 116,796 had them done after.

Because state Medicaid programs vary widely, the authors cautioned that their results may not be entirely transferable. They also noted that it wasn't clear from the data whether hospitals already serving high numbers of Medicaid patients provided more care or if more hospitals began to accept additional Medicaid patients.

Follow Andis Robeznieks on Twitter: @MHARobeznieks

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