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  • The Impact of the 2006 Massachusetts Healthcare Reform on Neurosurgical Procedures and Patient Insurance Status

    Final Number:

    Nicolas W. Villelli MD; Rohit Das; Hong Yan; Jian Zou; Nicholas M. Barbaro MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: The Massachusetts Healthcare Policy of 2006 has many similarities to the Affordable Care Act (ACA). There are concerns the ACA will negatively impact case volume and reimbursement for physicians. Analyzing neurosurgical cases and patient insurance status before and after the Massachusetts policy change can provide insight into the future of neurosurgery in the American healthcare system.

    Methods: The Massachusetts State Inpatient Database, which provides demographic information on hospital discharges, was studied for all neurosurgical ICD-9 procedure codes from 2001 to 2012. Four categories of ICD-9 codes were created: Tumor, Other Cranial/Vascular, Shunts and Spine. A comparison of case totals and uninsured cases, before and after the policy change, was performed. Data from New York were used as a control.

    Results: After 2008, there was a decrease in uninsured cases in all four categories in Massachusetts. The number of cases for Tumor and Spine were unchanged, while Other Cranial/Vascular increased. Shunt totals decreased post-policy, but exhibited a similar trend to the control. For New York, Spine case total and uninsured case volume increased, while Other Cranial/Vascular case totals decreased.

    Conclusions: After the Massachusetts Healthcare Reform, the number of uninsured individuals undergoing surgeries significantly decreased for all categories of neurosurgical procedures, but more importantly, the total number of cases did not change dramatically. To the extent that Massachusetts predicts the overall U.S. experience, some aspects of reimbursement may be positively impacted by the ACA. Neurosurgery, which treats patients with more urgent conditions, may be affected differently than other specialties.

    Patient Care: The American healthcare system is undergoing significant change with the implementation of The Affordable Care Act. It is unclear how neurosurgery will be impacted by this policy change. Massachusetts offers the opportunity to gain insight into how patient insurance status as well as reimbursements may change in a healthcare environment which requires insurance for all individuals.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand uninsured cases for all categories of neurosurgery declined in Massachusetts post-policy. 2) Recognize the total number of neurosurgical cases did not increase for the majority of procedure categories post-reform. 3) Discuss the potential impact of patient insurance status and case volume changes on reimbursements for neurosurgeons in a healthcare model which requires insurance for all individuals.

    References: 1. 2010 U.S. Census Bureau: State and County QuickFacts for Massachusetts. 2. 2010 U.S. Census Bureau: State and County QuickFacts for New York. 3. Census 2000 Data for the State of Massachusetts 4. Census 2000 Data for the State of New York 5. Anderson A: The Impact of the Affordable Care Act on the Health Care Workforce. 2014 6. Brinjikji W, Kallmes DF, Lanzino G, Cloft HJ: Hospitalization costs for endovascular and surgical treatment of ruptured aneurysms in the United States are substantially higher than Medicare payments. AJNR Am J Neuroradiol 33:1037-1040, 2012 7. Burdett G: Romneycare Vs. Obamacare: Key Similarities & Differences. 2013 8. Ellimoottil C, Miller S, Ayanian JZ, Miller DC: Effect of insurance expansion on utilization of inpatient surgery. JAMA Surg 149:829-836, 2014 9. Ellimoottil C, Miller S, Wei JT, Miller DC: Anticipating the impact of insurance expansion on inpatient urological surgery. Urol Pract 1:134-140, 2014 10. Hanchate AD, Lasser KE, Kapoor A, Rosen J, McCormick D, D'Amore MM, et al: Massachusetts reform and disparities in inpatient care utilization. Med Care 50:569-577, 2012 11. Hughey AB, Lesniak MS, Ansari SA, Roth S: What will anesthesiologists be anesthetizing? Trends in neurosurgical procedure usage. Anesth Analg 110:1686-1697, 2010 12. Loehrer AP, Song Z, Auchincloss HG, Hutter MM: Massachusetts health care reform and reduced racial disparities in minimally invasive surgery. JAMA Surg 148:1116-1122, 2013 13. McDonough JE, Rosman B, Butt M, Tucker L, Howe LK: Massachusetts health reform implementation: major progress and future challenges. Health Aff (Millwood) 27:w285-297, 2008 14. Rosenbaum S: The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public Health Rep 126:130-135, 2011 15. Rosenow JM, Orrico KO: Neurosurgeons' responses to changing Medicare reimbursement. Neurosurg Focus 37:E12, 2014 16. Toussaint RJ, Bergeron SG, Weaver MJ, Tornetta P, 3rd, Vrahas MS, Harris MB: The effect of the Massachusetts healthcare reform on the uninsured rate of the orthopaedic trauma population. J Bone Joint Surg Am 96:e141, 2014

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