States that have expanded Medicaid have seen their uninsured self-pay payer mix decline 31.2 percent since the start of 2014, while charity expenditures have declined 36.6 percent over the same period, according to new data released by Crowe Horwath, one of the largest public accounting, consulting and technology firms in the U.S.
The findings are part of the firm's third-quarter hospital data analysis, which examined patient account transactional data from 491 hospitals through Sept. 30, 2015.
"While the [Affordable Care Act] created some significant positive impacts for many hospitals, it's also created several challenges," Cory Herendeen, a principal in Crowe Performance Consulting, said in a news release. "There are a number of items — ranging from certain Medicare reimbursements to a hospital's tax-exempt status with the Internal Revenue Service — that are directly impacted by how much charity care that hospital provides. With more people insured today, less charity care is needed."
Here are six other findings from the analysis.
1. From September 2014 to September 2015, inpatient admissions increased 3.6 percent for nonexpansion states and decreased 1.4 percent for expansion states.
2. In Medicaid nonexpansion states, commercial/managed care payer mix increased approximately one percentage point while Medicaid expansion states saw a slight decline.
3. Outpatient volume from September 2014 to September 2015 dropped 2.8 percent for expansion states and 4.3 percent for nonexpansion states.
4. Average outpatient net revenue per case increased in Medicaid nonexpansion states by 4.1 percent from September 2014 to September 2015 while expansion states increased slightly, up 1.1 percent over the same period the year prior.
5. Compared with September 2014, average inpatient net revenue per case in Medicaid expansion states increased 2.7 percent while nonexpansion states remained flat.
6. In the analysis, the difference between Medicaid expansion states and nonexpansion states is largely attributed to high volume and low net revenue laboratory services delivered at a handful of hospitals in expansion states.
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