Health

Expanding Medicaid Has Not Improved Mission-Critical Access Hospitals

The expansion of Medicaid has not made critical access hospitals more financially stable or better at caring for patients than hospitals in states that are not expanding.

New research, published in the December issue of Health Affairs, found that these hospitals did not have improved quality scores or better staffing overall compared to critical access facilities in states that did not expand coverage.

“These results support the argument that while the expansion of Medicaid may have benefited some hospitals, it is not a panacea for all the problems facing hospitals serving rural and underserved communities,” the study authors write.

About one-third of US hospitals have been designated by the federal government as critical, which means they have fewer than 25 beds and are located more than 35 miles from the nearest hospital. Of the 1,158 critical access hospitals in the study, nearly 60% were in states that expanded Medicaid to a large proportion of residents.

The study found that there was not much difference between the amount of uncompensated care provided by these hospitals in any of the Medicaid conditions. And they saw a very small 1.3% increase in operating margins overall, which the researchers deemed insignificant.

“This increase in the number of lives covered by the Medicaid expansion should, in theory, make these hospitals more profitable, or at least start to break even, but they must also have a lot of very expensive technology or services. which, frankly, are not really being exploited. “These are independent factors that cannot be offset by increased Medicaid benefits,” said Jeff Myers, senior vice president of market access and cost recovery strategies at Catalyst Health Care Consulting. “Mission critical hospitals are by nature far from everything else and have a very limited number of users, which prevents them from spreading these fixed costs across multiple people.”

The researchers also looked at the Hospital Healthcare Consumer Assessment (HCAHPS), which basically measures patient satisfaction, heart failure, readmission rates, and pneumonia-related deaths. Hospitals in states that expanded Medicaid had nearly the same scores across all dimensions, as did hospitals in states that did not. Leah Binder, president of the nonprofit The Leapfrog Group, said improvements in these areas are usually driven by more direct efforts by payers and hospital management to improve quality, rather than simply increasing the number of patients covered.

“To truly improve quality and safety, hospitals need strong quality-oriented leadership, as well as a commitment to patient safety and putting patients first; if Medicaid or other funding rewards such superiority, we will see real improvements in the quality of care for those who operate hospitals, ”Binder said, but added that more attention needs to be paid to the quality and safety of critical hospitals, which are often not part of national measurement programs. …

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The study authors also believe that hospitals with critical access tend to provide care to patients who have less access to primary health care, as well as in communities with higher social determinants of health problems.

Congress is currently considering the Recovery Efficiency Act, which will increase health subsidies and expand Medicaid-like coverage to low-income residents in states that have opted not to expand Medicaid. But hospital groups have expressed concern that this will not necessarily benefit hospitals in the 12 remaining states that have not expanded.

Critical Access Hospitals data came from the Provider Expense Information System from Medicare and Medicaid Service Centers between 2011 and 2018.

Other studies that looked at the impact of expansion on hospitals showed an overall financial benefit, but did not focus solely on critical hospitals.


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