Dive Brief:
- The Robert Wood Johnson Foundation said July 8 it is partnering with 24 state hospital associations to track health reform's impact on hospital utilization.
- The RWJF Hospital ACA Monitoring Project will collect quarterly data on all inpatient admissions and emergency department visits by payer. The project also will gather information on a subset of diagnoses and procedures, including inpatient admissions for knee replacements.
- Seventeen state hospital associations provided information from individual hospitals, and seven submitted state-level data. In all, about 1,700 hospitals, or roughly one-third of U.S. hospitals, are included in the data set. Two-thirds are acute-care, and some are critical access hospitals.
Dive Insight:
According to RWJF, conventional wisdom might suggest that coverage expansion will result in fewer preventable hospitalizations and less inappropriate ED use. Yet Oregon's experiment increasing Medicaid enrollment actually resulted in more ED use. Isn't it possible that increased demand for primary care could overwhelm the ambulatory care system, leading to more hospital use for primary care treatable conditions, even among previously insured people?
RWJF said reform's potential financial impact on hospitals is also unclear. Reducing uncompensated care is clearly a benefit, but there may be significant increases in utilization by patients covered by payers reimbursing at relatively low rates. Also, there is a possibility of increased bad debt from patients in exchange plans requiring significant cost-sharing. And there are reductions in Disproportionate Share Hospital (DSH) payments and other changes in Medicare payments.
The RWJF-led effort aims to shed light on these types of questions and to provide timely data to researchers, policymakers and hospital leaders. RWJF released baseline 2013 data showing about 20% of ED visits are attributable to the uninsured, vs. about 6% of inpatient admissions. Hospitals' utilization data for first-quarter 2014 are expected by the end of summer.