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The Financial Toxicity of Government Payers
Bridget C. Olsen
*1, Laura M. Nicolais
2, Aurora Quaye
3, Janelle Richard
3, Peter Hubbs
3, Timothy L. Fitzgerald
11Surgery, Maine Medical Center, Portland, ME; 2Surgery, Cook County Health, Chicago, IL; 3Department of Anesthesiology, Maine Medical Center, Portland, ME
Background. Surgeons must understand the implications of increased federal scrutiny of hospital reimbursement for surgical patents. Decreases might further destabilize financially struggling hospitals and healthcare systems where surgical care is provided. This study reviews net income for surgical patients stratified by patient risk factors.
Study Design. Single hospital retrospective cohort study from 7/2021-12/2022.
Results. 6,186 patients were included; 4,029 had Medicare (56%) and 538 had Medicaid/self-pay (9%). For patients with government insurance, patients with Medicaid were more likely to be female (54.3% vs 46.3%, p < 0.001), non-white (10.4 vs. 3.2, < 0.001), younger, and non-frail (98.7 vs. 83.3, p < 0.001) than those with Medicare but similar in ASA score and surgical complexity. Medicaid had a significantly higher loss than Medicare, $-7,390 vs. -3,275, p < 0.001). Patients were stratified by risk category: ASA (1/2 vs. 3/4/5), operative complexity (high vs. low), and frailty (< vs. > = RAI 31). Losses were higher for patients with high ASA ($-4,504 vs. -2,232, p < 0.001) and frailty ($-5,506 vs. -3,536, p=0.005) but similar for operative risk (p=0.1). On multivariate analysis for patients with Medicare, higher losses were more common in male patients (OR 1.2, p=0.004) and less complex procedures (OR 2.0, p < 0.0001) but similar for race, gender, and frailty. For Medicaid, the loss was identical for all groups except men (OR 1.6, p=0.005).
Conclusions. For surgical patients, regardless of patient risk factors or demographics, hospitals operate at a net loss for Medicare and Medicaid. Given the potential for decreasing federal reimbursement, hospitals and surgeons could anticipate a negative financial impact on hospital finances that will disproportionately affect regions with higher exposure to Medicaid and Medicare.
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