Association of Insurance Type with Inpatient Surgical 30-day Readmissions, Emergency Department Visits/Observation Stays, and Costs

Authors

Michael A Jacobs
Jeongsoo Kim
Jasmine C Tetley
Susanne Schmidt
Bradley B Brimhall
Virginia Mika
Chen-Pin Wang
Laura S Manuel
Paul Damien
Paula K Shireman

Language

English

Publication Date

3-1-2023

Journal

Annals of Surgery Open

DOI

10.1097/as9.0000000000000235

PMID

37588413

PMCID

PMC10427129

PubMedCentral® Posted Date

2-14-2023

PubMedCentral® Full Text Version

Post-print

Abstract

Objective: To assess the association of Private, Medicare, and Medicaid/Uninsured insurance type with 30-day Emergency Department visits/Observation Stays (EDOS), readmissions, and costs in a safety-net hospital (SNH) serving diverse socioeconomic status patients.

Summary background data: Medicare's Hospital Readmission Reduction Program (HRRP) disproportionately penalizes SNHs.

Methods: This retrospective cohort study used inpatient National Surgical Quality Improvement Program (2013-2019) data merged with cost data. Frailty, expanded Operative Stress Score, case status, and insurance type were used to predict odds of EDOS and readmissions, as well as index hospitalization costs.

Results: The cohort had 1,477 Private; 1,164 Medicare; and 3,488 Medicaid/Uninsured cases with a patient mean age 52.1 years [SD=14.7] and 46.8% of the cases were performed on male patients. Medicaid/Uninsured (aOR=2.69, CI=2.38-3.05, P< .001) and Medicare (aOR=1.32, CI=1.11-1.56, P=.001) had increased odds of urgent/emergent surgeries and complications versus Private patients. Despite having similar frailty distributions, Medicaid/Uninsured compared to Private patients had higher odds of EDOS (aOR=1.71, CI=1.39-2.11, P< .001), and readmissions (aOR=1.35, CI=1.11-1.65, P=.004), after adjusting for frailty, OSS, and case status, while Medicare patients had similar odds of EDOS and readmissions versus Private. Hospitalization variable cost %change was increased for Medicare (12.5%) and Medicaid/Uninsured (5.9%), but Medicaid/Uninsured was similar to Private after adjusting for urgent/emergent cases.

Conclusions: Increased rates and odds of urgent/emergent cases in Medicaid/Uninsured patients drive increased odds of complications and index hospitalization costs versus Private. SNHs care for higher cost populations while receiving lower reimbursements and are further penalized by the unintended consequences of HRRP. Increasing access to care, especially for Medicaid/Uninsured patients, could reduce urgent/emergent surgeries resulting in fewer complications, EDOS/readmissions, and costs.

Keywords

emergency department visits, healthcare disparities, observation stays, readmissions, social risk factors

Published Open-Access

yes

Recommended Citation

Jacobs, Michael A; Kim, Jeongsoo; Tetley, Jasmine C; et al., "Association of Insurance Type with Inpatient Surgical 30-day Readmissions, Emergency Department Visits/Observation Stays, and Costs" (2023). Faculty, Staff and Student Publications. 5903.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/5903