IMPACT OF AFFORDABLE CARE ACT ON MEDICARE DISPROPORTIONATE SHARE HOSPITAL (DSH) PAYMENTS
Author(s)
Haider MR, Siddiqi KA, Demir I, Khan MM
University of South Carolina, Columbia, SC, USA
Presentation Documents
OBJECTIVES Disproportionate Share Hospital (DSH) payments historically acted as a source for the unpaid expenditure borne by the hospitals for the uninsured and underinsured patients. Under the auspices of Patient Protection and Affordable Care Act (ACA), it is projected by Center for Medicare and Medicaid Services (CMS) that with decrease in the number of uninsured under ACA, DSH payments will also decrease. This study investigates the extent of the Medicare DHS payment reduction in relation with facility level factors affect that reduction in the wake of ACA. METHODS We analyzed six years’ Medicare DSH payment data from 2010 to 2015 collected from Healthcare Cost Reporting Information System. Since the ACA regulation pertaining to DSH payment has promulgated in 2014, we considered 2010-2013 as the pre-ACA and 2014-2015 as the post-ACA period. Descriptive statistics were explored along with regression analysis for finding the potential factors driving the DSH payments. All analyses were performed using STATA 14.2. RESULTS The mean Medicare DSH payments paid to the hospitals are 3.1 million and 1.1 million in pre- and post-ACA respectively. In post-ACA period, Medicare DSH payment reduction was almost similar for ACA implementing states (63%) and non-implementing states (67%). In multivariable analysis results show that ACA has decreased Medicare DSH payments after controlling for regions, hospital bed size, and number of hospital days. CONCLUSIONS Study results found that ACA has a significant impact on Medicare DSH payments all over the US irrespective of ACA implementation. Although the uninsured decreased in number, the rate at which it decreased (43%, 16% in 2010 and 9% in 2015) does not match the two-third deduction of DSH payments from the pre-ACA period. It requires further investigation at the financial wellbeing of the hospitals as well as the physical wellbeing of the uninsured patients.
Conference/Value in Health Info
2018-05, ISPOR 2018, Baltimore, MD, USA
Value in Health, Vol. 21, S1 (May 2018)
Code
PHS151
Topic
Health Policy & Regulatory
Topic Subcategory
Approval & Labeling
Disease
Multiple Diseases