New program tracks ACA's effect on hospitals

The Robert Wood Johnson Foundation will collaborate with 24 state hospital associations to track the Affordable Care Act's (ACA) effect on hospital utilization.

The Hospital ACA Monitoring Project (HAMP) will compile quarterly data on inpatient admissions and emergency department (ED) visits, as well as information on diagnoses believed to hinge on insurance status, according to an announcement. While expanded health coverage would seem to indicate a drop in ED use and preventable hospitalizations, there are concerns that increased primary care utilization may strain ambulatory care, the announcement states.

How the ACA will affect hospitals financially also remains ambiguous. A reduction in uncompensated care may be accompanied by ramped-up utilization by patients whose payers reimburse at lower rates, along with the risk of increased bad debt from patients covered under marketplace plans and the looming specter of cuts to disproportionate share hospital payments.

HAMP obtained individual hospital data from 17 state hospital associations and state-level figures from seven more, according to the announcement, with the final data set incorporating about 1,700 hospitals--about one in three.

HAMP also collected data on three preventable causes of inpatient hospitalizations, as defined by the Agency for Health Research and Quality, including short-term consequences of diabetes, hypertension and urinary tract infection. The project also intends to monitor knee replacement admissions, due to the procedure's sensitivity to insurance status, and three diagnoses considered primary care treatable or ambulatory care sensitive: headache, upper respiratory infection and urinary tract infection, the foundation said.

Baseline 2013 data found that while there was relatively little uncompensated care in states that expanded Medicaid eligibility, several of those states (including Colorado, Kentucky, Nevada and New Jersey) saw substantial self-pay utilization for both the ED and inpatient care in 2013. "Depending on the degree of eligibility and take-up among these uninsured patients, these states may experience a fairly significant change in utilization patterns upon expansion," the announcement states.

To learn more:
- read the announcement
- here's the data set (PowerPoint)

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