Medicaid surgery patients likely to be sicker, stay in hospitals longer

Hospitals in states that expanded Medicaid eligibility under the Affordable Care Act may get paid to care for patients that were previously uninsured, but it could come with a catch: The patients are sicker and will stay in the hospital longer.

A new study by University of Michigan Health System researchers concluded that many Medicaid patients who underwent surgery in the state had conditions that contributed to longer stays and higher cost, including diabetes, lung disease and vascular issues, the New York Times reported. The average length of stay for Medicaid surgical patients was three days, as opposed to two days for other patients--an increase of 50 percent, according to the study.

"The Medicaid patients were sicker, and they did not do as well following surgery. They stayed in the hospital longer, and that increases the cost," Darrell A. Campbell, M.D., the chief medical officer of the University of Michigan Health System, told the New York Times. He further suggested that given Medicaid expansion has also come with payments cuts from the Disproportionate Share Hospital program, these demographics could spell financial trouble for facilities that treat large number of Medicaid patients.

The study, which followed nearly 14,000 Medicaid patients treated at 52 Michigan hospitals, was published in this month's edition of the journal JAMA Surgery.

Michigan, which has a Republican governor and GOP-controlled legislature, recently chose to expand Medicaid eligibility after an often contentious debate on the issue. Hospitals in the state say the decision will help stabilize their bottom lines. However, two dozen states have declined so far to expand Medicaid eligibility, with leaders in many claiming it would be too much of a financial burden.

Campbell suggested that hospitals be more aggressive in preoperative care for Medicaid patients in order to better control costs. "Being a heavy smoker predisposes you to get pneumonia after an operation. For a diabetic, if blood sugar is out of control, that increases the chances of a wound infection after surgery. If we can address these issues preoperatively, we can cut down the problems we see after an operation," he said.

To learn more:
- read the New York Times article
- read the study preview