The Affordable Care Act and its association with length of stay and payer status for trauma patients at a level I trauma center.

Background: We hypothesized that the ACA would shorten length of stay and increase numbers of insured patients without changing trauma patient outcomes.

Methods: A retrospective review of adult trauma patients admitted to a level I trauma center between 2012 and 2014 was performed. Demographics, length of stay, payer status, discharge disposition, and complications before and after the ACA implementation were analyzed.

Results: 4448 trauma patients were admitted during the study period. Patients treated after ACA implementation were older (53 vs 51, p = 0.05) with shorter ICU stays (1.7 vs 1.5 days, p = 0.04), but longer overall hospital stays (3.7 vs 4.1 days, p < 0.01). The proportion of self-pay patients decreased 11%-3% (p=<0.001). A higher proportion of patients were discharged to skilled nursing facilities (SNF, 17.1% vs 19.9%, p = 0.02). There was no change in rates of death, readmission, infection, pneumonia or decubiti.

Conclusion: Among trauma patients, there was a decrease in self-pay status and increase in public insurance without change in private insurance after implementation of the ACA. More patients were discharged to SNF without changes in reported outcomes.