“When Medicare cuts prices, it looks like hospitals figure out how to operate in a lower-cost way,” he said in an interview.
Many hospitals are moving aggressively to tighten spending on labor and supplies and to streamline care in response to recent and anticipated reductions in rates from public and private payers.
Under the ACA, Medicare will pay hospitals 1.1% less a year over a decade, starting in 2011, than it would have paid without the law, the study said.
That's $321 less per patient after 10 years, using a definition that accounts for patients who were admitted and those treated as outpatients, according to the paper. That takes into account the likelihood that private payers will cut prices as Medicare does.
The paper found that hospitals were mostly able to protect their operating margins as Medicare lowered prices between 1996 and 2009.
During that period, Medicare rate cuts—principally a result of the Balanced Budget Act of 1997—reduced hospital revenue by 2.5%. That amounted to $250 for each hospital patient.
Hospitals did not see revenue from other payers increase as Medicare prices declined. In fact, total patient revenue dropped $1.55 for every $1 drop in Medicare revenue, the study said. The results suggest that when Medicare cuts prices, so do other payers, White said. In research published this year in the journal Health Affairs, White reported that private insurance rates dropped 3% to 8% when Medicare prices declined 10%.
Hospitals offset $1.40 in lost revenue by spending less to operate. Most of those spending cuts—60%—came from labor costs.
White and co-author Vivian Yaling Wu, an assistant professor at the University of Southern California who specializes in health economics and finance, Los Angeles, estimated that the ACA's $321 per-patient reduction in hospital revenue over 10 years would require $290 per patient drop in operating costs and $30 per patient loss in operating margin.
The study did not include hospitals in Maryland, where the state sets prices for all payers. Small and rural hospitals that have been federally designated as “critical access” hospitals also were excluded.