In the Journals

Medicaid expansion boosts PCI, CABG procedures, but fails to change outcomes

Expanded Medicaid coverage in Michigan under the Affordable Care Act led to more younger patients undergoing PCI and CABG, but did not affect rate of mortality, incidence of acute kidney injury or length of stay, according to a research letter published in the Journal of the American College of Cardiology.

According to the study background, Michigan expanded Medicaid coverage in April 2014, and 600,000 adults were newly enrolled by April 2015.

The researchers compared access and outcomes from up to 24 months before vs. up to 24 months after Medicaid expansion for 7,558 CABG procedures at 33 hospitals and 45,183 PCI procedures at 47 hospitals. Patients aged 65 years or older were excluded.

Outcomes of interest included changes in number of procedures by insurance type, mortality, procedural appropriateness, acute kidney injury and length of stay.

After expansion, there was a 103.8% increase in Medicaid patients who presented for CABG (95% CI, 45.8-182.5) and a 44.5% increase in Medicaid patients who presented for PCI (95% CI, 24.6-69.9), Donald S. Likosky, PhD, associate professor of cardiac surgery at the University of Michigan, and colleagues wrote.

Among patients who had CABG, there was a 59.6% decrease in uninsured patients (95% CI, 41.5-72.1) and an 8.3% decrease in those who had private insurance (95% CI, 0.2-20.1) after expansion, whereas among those who had PCI after expansion, there was a 53.2% decline in uninsured patients (95% CI, 46.1-59.3) and a 16.3% decline in those with private insurance (95% CI, 10.2-22.4), according to the researchers, who wrote that the bulk of the changes occurred in the first quarter after expansion.

Medicaid expansion was not associated with mortality, acute kidney injury or length of stay regardless of type of insurance coverage (P > .05 for all), the researchers wrote, noting mortality was similar before and after expansion for CABG (before, 0.95%; after, 1.03%) and PCI (before, 1.07%; after, 0.98%). In the Medicaid population, mortality for CABG (before, 1.27%; after, 1.31%) and PCI (before, 1.63%; after, 1.35%) was also similar across time.

Expansion did not affect appropriateness of PCI (before, 88%; after, 91%) or CABG (before, 89%; after, 90%), and changes in appropriateness did not differ across insurance types, Likosky and colleagues wrote.

“Despite the concern that some Medicaid patients may be sicker than those with Medicare or private insurance and therefore at higher risk of poor outcomes, quality of care for cardiovascular procedures across Michigan was unchanged following Medicaid expansion,” Likosky said in a press release. – by Erik Swain

Disclosure: One author reports he is a consultant for Osprey Medical.

Expanded Medicaid coverage in Michigan under the Affordable Care Act led to more younger patients undergoing PCI and CABG, but did not affect rate of mortality, incidence of acute kidney injury or length of stay, according to a research letter published in the Journal of the American College of Cardiology.

According to the study background, Michigan expanded Medicaid coverage in April 2014, and 600,000 adults were newly enrolled by April 2015.

The researchers compared access and outcomes from up to 24 months before vs. up to 24 months after Medicaid expansion for 7,558 CABG procedures at 33 hospitals and 45,183 PCI procedures at 47 hospitals. Patients aged 65 years or older were excluded.

Outcomes of interest included changes in number of procedures by insurance type, mortality, procedural appropriateness, acute kidney injury and length of stay.

After expansion, there was a 103.8% increase in Medicaid patients who presented for CABG (95% CI, 45.8-182.5) and a 44.5% increase in Medicaid patients who presented for PCI (95% CI, 24.6-69.9), Donald S. Likosky, PhD, associate professor of cardiac surgery at the University of Michigan, and colleagues wrote.

Among patients who had CABG, there was a 59.6% decrease in uninsured patients (95% CI, 41.5-72.1) and an 8.3% decrease in those who had private insurance (95% CI, 0.2-20.1) after expansion, whereas among those who had PCI after expansion, there was a 53.2% decline in uninsured patients (95% CI, 46.1-59.3) and a 16.3% decline in those with private insurance (95% CI, 10.2-22.4), according to the researchers, who wrote that the bulk of the changes occurred in the first quarter after expansion.

Medicaid expansion was not associated with mortality, acute kidney injury or length of stay regardless of type of insurance coverage (P > .05 for all), the researchers wrote, noting mortality was similar before and after expansion for CABG (before, 0.95%; after, 1.03%) and PCI (before, 1.07%; after, 0.98%). In the Medicaid population, mortality for CABG (before, 1.27%; after, 1.31%) and PCI (before, 1.63%; after, 1.35%) was also similar across time.

Expansion did not affect appropriateness of PCI (before, 88%; after, 91%) or CABG (before, 89%; after, 90%), and changes in appropriateness did not differ across insurance types, Likosky and colleagues wrote.

“Despite the concern that some Medicaid patients may be sicker than those with Medicare or private insurance and therefore at higher risk of poor outcomes, quality of care for cardiovascular procedures across Michigan was unchanged following Medicaid expansion,” Likosky said in a press release. – by Erik Swain

Disclosure: One author reports he is a consultant for Osprey Medical.