Presentation Authors: Scott Wiener*, David Bayne, San Francisco, CA, David Tzou, Tuscon, AZ, Thomas Chi, Marshall Stoller, San Francisco, CA
Introduction: In March 2010 the Affordable Care Act (ACA) was signed into law, yet health insurance markets did not become fully operational until January 2014. We hypothesized that enactment of this legislation would alter the payer distribution for kidney stone patients undergoing ureteroscopy (URS), shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL) in California (CA).
Methods: We utilized CA&[prime]s Office of Statewide Health Planning and Development (OSHPD) public inpatient and ambulatory surgical databases from 2011-2016 to examine URS, SWL, and PCNL operations for nephrolithiasis. Data was obtained on an aggregate level and split into two eras: 2011-2013 (pre-implementation) and 2014-2016 (post-implementation). The proportion of patients/procedures was compared for payer type by Chi square test for independence before and after the ACA. ArcMap 10.5 Software (ERSI, Redlands, CA) was used to create the choropleth map of CA labor market regions.
Results: A total of 86,437 procedures were performed from 2011-2013, while 95,866 were performed from 2014-2016. After 2014, the number of operations performed on Medicaid patients increased by 88% (from 8,878 to 16,717, p < .01, Figure), while operations on the uninsured dropped by 67% (from 2,887 to 1,676, p < .01, Figure) with a ratio of 6.5:1 in favor of increased Medicaid operations. When examined by CA region, wide variability was noted with a range of -4% to +214% for the change in procedures on Medicaid patients (Figure). Counts for privately insured and Medicare patients increased without abrupt change after 2014.
Conclusions: The ACA drastically altered the payer mix for patients undergoing surgery for urinary stone disease, however not all geographic regions experienced the same degree of change. The ACA also may have improved access to stone surgery given that the increase in Medicaid patients was 6.5 times larger than the decrease in uninsured patients. It remains to be seen if the observed variation by geography is due to patient or system related factors.