AI Article Synopsis
- Uninsured trauma patients face higher risks, such as mortality and poor access to care, but Hospital Presumptive Eligibility (HPE) allows them to gain emergency Medicaid during hospitalization.
- A study examined factors affecting HPE approval in trauma patients between 2015 and 2019, finding that 40.8% of uninsured patients acquired HPE, especially those with higher Injury Severity Scores (ISS) and longer hospital stays.
- Key findings revealed that Hispanic patients and those with higher ISS had increased chances of HPE approval, highlighting the need for better intervention strategies for uninsured individuals at the time of injury.
Article Abstract
Introduction: Uninsured trauma patients are at higher risk of mortality, limited access to postdischarge resources, and catastrophic health expenditure. Hospital Presumptive Eligibility (HPE), enacted with the 2014 Affordable Care Act, enables uninsured patients to be screened and acquired emergency Medicaid at the time of hospitalization. We sought to identify factors associated with successful acquisition of HPE insurance at the time of injury, hypothesizing that patients with higher Injury Severity Score (ISS) (ISS >15) would be more likely to be approved for HPE.
Methods: We identified Medicaid and uninsured patients aged 18 to 64 years with a primary trauma diagnosis (International Classification of Diseases, Tenth Revision) in a large level I trauma center between 2015 and 2019. We combined trauma registry data with review of electronic medical records, to determine our primary outcome, HPE acquisition. Descriptive and multivariate analyses were performed.
Results: Among 2,320 trauma patients, 1,374 (59%) were already enrolled in Medicaid at the time of hospitalization. Among those uninsured at arrival, 386 (40.8%) acquired HPE before discharge, and 560 (59.2%) remained uninsured. Hospital Presumptive Eligibility patients had higher ISS (ISS >15, 14.8% vs. 5.7%; p < 0.001), longer median length of stay (2 days [interquartile range, 0-5 days] vs. 0 [0-1] days, p < 0.001), were more frequently admitted as inpatients (64.5% vs. 33.6%, p < 0.001), and discharged to postacute services (11.9% vs. 0.9%, p < 0.001). Patient, hospital, and policy factors contributed to HPE nonapproval. In adjusted analyses, Hispanic ethnicity (vs. non-Hispanic Whites: aOR, 1.58; p = 0.02) and increasing ISS (p ≤ 0.001) were associated with increased likelihood of HPE approval.
Conclusion: The time of hospitalization due to injury is an underused opportunity for intervention, whereby uninsured patients can acquire sustainable insurance coverage. Opportunities to increase HPE acquisition merit further study nationally across trauma centers. As administrative and trauma registries do not capture information to compare HPE and traditional Medicaid patients, prospective insurance data collection would help to identify targets for intervention.
Level Of Evidence: Economic, level IV.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/TA.0000000000003195 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Segregation in hospital care for Medicare beneficiaries by race and ethnicity and dual-eligible status from 2013 to 2021.
Health Serv Res
January 2025
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Objective: To examine the extent of segregation between hospitals for Medicare beneficiaries by race, ethnicity, and dual-eligible status over time.
Data Sources And Study Setting: We used Medicare inpatient hospital provider data for fee-for-service (FFS) beneficiaries, and the Dartmouth Atlas of Health Care from 2013 to 2021 nationwide, for hospital referral regions (HRRs), and for and hospital service areas (HSAs).
Study Design: We conducted time trend analysis with dissimilarity indices (DIs) for Black (DI-Black), Hispanic (DI-Hispanic), non-White (including Black, Hispanic, and other non-White) (DI-non-White), and dual-eligible (DI-Dual) beneficiaries.
The Impact of Medicaid Expansion on Stage at Diagnosis of Melanoma Patients: A Retrospective Study.
Cancers (Basel)
December 2024
City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA.
Background: This study addresses the lack of research on Medicaid expansion's impact on melanoma staging, treatment utilization, and outcomes by evaluating its effects under the Affordable Care Act (ACA), particularly focusing on staging at diagnosis, treatment use, and 3-year mortality outcomes. The objective is to determine whether Medicaid expansion led to earlier melanoma diagnosis and improved survival rates among non-elderly adults (ages 40-64) by analyzing data from the National Cancer Database (NCDB).
Methods: A total of 12,667 patients, aged 40-64, diagnosed with melanoma from 2010 to 2020 were identified using the NCDB.
Consistency in Self-Reported Race-and-Ethnicity Over Time: Implications for Improving the Accuracy of Imputations and Making the Best Use of Self-Report.
Med Care
February 2025
RAND, Health Care, Santa Monica, CA.
Background: Medicare Bayesian Improved Surname and Geocoding (MBISG), which augments an imperfect race-and-ethnicity administrative variable to estimate probabilities that people would self-identify as being in each of 6 mutually exclusive racial-and-ethnic groups, performs very well for Asian American and Native Hawaiian/Pacific Islander (AA&NHPI), Black, Hispanic, and White race-and-ethnicity, somewhat less well for American Indian/Alaska Native (AI/AN), and much less well for Multiracial race-and-ethnicity.
Objectives: To assess whether temporal inconsistency of self-reported race-and-ethnicity might limit improvements in approaches like MBISG.
Methods: Using the Medicare Health Outcomes Survey (HOS) baseline (2013-2018) and 2-year follow-up data (2015-2020), we evaluate the consistency of self-reported race-and-ethnicity coded 2 ways: the 6 mutually exclusive MBISG categories and individual endorsements of each racial-and-ethnic group.
Unlabelled: Policy Points A redirection of measurement in health care from a narrow focus on diseases and care processes towards assessing whole person health, as perceived by the person themself, may provide a galvanizing view of how health care can best meet the needs of people and help patients feel heard, seen, and understood by their care team. This review identifies key tensions to navigate as well as four overarching categories of whole person health for consideration in developing an instrument optimized for clinical practice. The categories (body and mind, relationships, living environment and finances, and engagement in daily life) include nine constituent domains.
View Article and Find Full Text PDFThe Financial Impact of Ehlers-Danlos Syndromes on Patients in the United States in 2022.
Mayo Clin Proc Innov Qual Outcomes
February 2025
Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN.
Objective: To determine the financial impact of Ehlers-Danlos syndromes (EDS) on patients in the United States by examining the medical expenses incurred by patients.
Patients And Methods: We used a convenience sample approach and disseminated a self-reported survey questionnaire to individuals with EDS via patient advocacy organizations and support groups across the country, social media, and health professionals from April 1, 2023, to December 31, 2023. The survey focused on the out-of-pocket medical expenses incurred by patients.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!