Increased Access to Cardiac Surgery Did Not Improve Outcomes: Early Look into Medicaid Expansion.

Abstract

BACKGROUND\nCardiac surgery utilization has increased after passage of the Affordable Care Act. This multi-state study examined whether changes in access after Medicaid Expansion (ME) have led to improved outcomes, overall and particularly among ethno-racial minorities.\n\n\nMETHODS\nState Inpatient Databases were used to identify non-elderly adults (ages 18-64) who underwent coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, or mitral valve repair in three expansion (Kentucky, New Jersey, Maryland) vs two non-expansion states (North Carolina, Florida) from 2012 to 2015. Linear and logistic Interrupted Time Series (ITS) were used with two-way interactions and adjusted for patient, hospital, and county-level factors to compare trends and instantaneous changes at the point of ME implementation (Q1 2014) for mortality, length of stay (LOS), and elective status. ITS models estimated expansion effect, overall and by race-ethnicity.\n\n\nRESULTS\nAnalysis included 22,038 cardiac surgery patients from expansion states and 33,190 from non-expansion states. In expansion states, no significant trend changes were observed for mortality (OR 1.01, p=0.83) or LOS (β= -0.05, p=0.20), or elective surgery (OR 1.00, p=0.91). There were similar changes seen in non-expansion states. Among ethno-racial minorities, ME did not impact outcomes or elective status.\n\n\nCONCLUSIONS\nDespite an increase in cardiac surgery utilization following ME, outcomes remained unchanged in the early period after implementation, overall and among ethno-racial minorities. Future research is needed to confirm long-term trends and examine reasons behind this lack of improved outcomes.