title: Initial impact of the Affordable Care Act on an Ohio Level I trauma center.
abstract: Hospital financial pressures and inadequate reimbursement contribute to the closure of trauma centers. Uninsured patients contribute significantly to the burden of trauma center costs. The Affordable Care Act implemented changes in 2014 to provide health care coverage for all Americans. This study analyzes the impact of the recent health care changes on an Ohio Level I trauma center financials.
  
  
  
  We conducted an analysis of trauma charges, reimbursement, and supplemental payments at an Ohio Level I trauma center. A 3-year trauma patient cohort (2012-2014) was selected and grouped by reimbursement source (Medicare, Medicaid, other government, commercial, and self-pay/charity). A total of 9,655 patients were reviewed. Data were collected with the Transition Systems Inc. accounting system and analyzed with IBM SPSS Statistics 22.0.
  
  
  
  For trauma cases, the percentage of self-pay/charity patients decreased during the 2012 to 2014 period (15.1%, 15%, to 6.4%, respectively), while the percentage of Medicaid decreased from 2012 to 2013 followed by a large increase in 2014 (15.4%, 13.9%, to 24.3%, respectively). The percentage of commercially insured patients decreased slightly from 2012 to 2014 (34.2%, 32.3%, to 30.7%, respectively). Uninsured charges decreased notably (approximately $22.5 million and $21 million for 2012-2013 to approximately $8.6 million in 2014). Medicaid charges decreased from 2012 to 2013, followed by a rebound in 2014 ($50.7 million in 2012 to $37.3 million in 2013 to $54.3 million in 2014). The percentage of total charges for self-pay/charity decreased (9.5%, 10.1%, to 4.1%). The percentage of total charges for Medicaid increased (21.4%, 18.0%, to 25.9%). Mean Medicaid reimbursement per patient decreased ($19,000, $14,000, to $13,000). Mean reimbursement per uninsured patient did not vary significantly among years. Total hospital supplemental payments (trauma and nontrauma combined) decreased ($47.6 million, $49 million, to $39.2 million).
  
  
  
  In the first year following the changes implemented by the Affordable Care Act, our hospital saw self-pay/charity charges decrease, Medicaid charges increase, and total hospital supplemental payments decrease. In addition, there was a small, yet noteworthy, downward trend in the number of commercially insured patients. Although more data collection and analysis are needed, this initial financial evaluation of a Level I trauma center following the Affordable Care Act provides insight into insurance trends.
authors.affiliation: From the Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Cheslik
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Bukkapatnam
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Markert
authors.forename: Charles H
authors.initials: CH
authors.lastname: Dabbs
authors.forename: Akpofure Peter
authors.initials: AP
authors.lastname: Ekeh
authors.forename: Mary C
authors.initials: MC
authors.lastname: McCarthy
mesh_terms: D017722:Hospital Charges / Q000639:trends; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008484:Medicaid / Q000191:economics; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics; D009820:Ohio; D058991:Patient Protection and Affordable Care Act; D014193:Trauma Centers / Q000191:economics*; D014481:United States