DID THE ACA MEDICAID EXPANSION AFFECT RATES OF ELECTIVE SIGMOID COLECTOMY FOR DIVERTICULITIS?
Arthur G. Affleck*, Vassiliki L. Tsikitis, Saunders Lin
SURGERY, OHSU, Portland, OR
The Affordable Care Act expanded access to Medicaid coverage and has been associated with an increase in utilization of many surgical procedures, however the effect on elective sigmoid colectomy for diverticulitis is unknown. Elective surgical treatment is the standard of care for patients with recurrent or chronic diverticular disease, as operations conducted in an elective setting are likely performed by a minimally invasive approach and associated with better outcomes. The aim of this study is to evaluate whether implementation of the Affordable Care Act Medicaid expansion was associated with an increase in elective sigmoid colectomy for diverticulitis.
We used a case control design to compare elective sigmoid colectomy for diverticulitis at the facility level by patient demographic characteristics and insurance payer categories using the State Ambulatory Surgery and Services Database of the Healthcare Cost and Utilization Project between expansion states (New York and Michigan) and non-expansion states (North Carolina and Florida). The year 2013 was used as the pre-expansion period, and the year 2016 was used as the post-expansion period. A negative binomial differences-in-differences model was used to evaluate changes in the number of procedures following Medicaid expansion.
Medicaid expansion was associated with an increase in the utilization of total number of elective colectomies. Particularly minimally invasive sigmoid colectomy rates were increased among Medicaid patients. For all colectomies for diverticular disease, Medicaid patients saw a 93% increase in expansion states vs. non-expansion states (IRR 1.93, 95% CI 1.30 to 2.86). For laparoscopic colectomy, Medicaid patients saw a 63% increase (IRR 1.63, 95% CI 1.02 to 2.59). We saw no significant difference in expansion states and non-expansion states in the overall number of all elective and emergent colectomies for diverticular disease regardless of insurance. Furthermore, there were no significant differences in colectomy rates when stratified by race in expansion states vs. non-expansion states.
Conclusions: There was an increase in both the total number of elective and laparoscopic sigmoid colectomy rates for diverticular disease for Medicaid patients in the Medicaid expansion states. However, this did not significantly affect the overall number of all colectomies performed for diverticular disease between the two groups, and no differences were seen when stratified by race.
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