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Background. The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update. Methods. We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015). Results. Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals CI: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points 95%CI: -2.9, 0.2, p < 0.1, after multivariable adjustment. Conclusions. We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.
Keywords
Affordable Care Act, multiple chronic conditions, emergency department (ED) visits, inpatient visits, length of stay (LOS), older adults, Medicare.
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CURRENT STATUS: Published
View the published article at BMC Health Services Research.
Version 3
Posted 13 Jan, 2020
No community comments so far
Editorial decision: Accept
On 13 Jan, 2020
Editor assigned
On 10 Jan, 2020
Submission checks complete
On 09 Jan, 2020
Editor invited
On 09 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 07 Jan, 2020
Review #1 received
Received 14 Dec, 2019
Reviewer #2 agreed
On 02 Dec, 2019
Review #2 received
Received 02 Dec, 2019
Editor assigned
On 28 Nov, 2019
Reviewers invited
Invitations sent on 28 Nov, 2019
Reviewer #1 agreed
On 28 Nov, 2019
Submission checks complete
On 27 Nov, 2019
Editor invited
On 27 Nov, 2019
No comments provided
Editorial decision: Major revision
On 06 Nov, 2019
Review #2 received
Received 25 Oct, 2019
Reviewer #2 agreed
On 02 Oct, 2019
Review #1 received
Received 18 Jul, 2019
Reviewer #1 agreed
On 08 Jul, 2019
Reviewers invited
Invitations sent on 06 Jul, 2019
Submission checks complete
On 18 Jun, 2019
Editor invited
On 13 Jun, 2019
Editor assigned
On 13 Jun, 2019
First submitted
On 11 Jun, 2019
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See the published version of this preprint at BMC Health Services Research.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Health Services Research.
Version 3
Posted 13 Jan, 2020
No community comments so far
Editorial decision: Accept
On 13 Jan, 2020
Editor assigned
On 10 Jan, 2020
Submission checks complete
On 09 Jan, 2020
Editor invited
On 09 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 07 Jan, 2020
Review #1 received
Received 14 Dec, 2019
Reviewer #2 agreed
On 02 Dec, 2019
Review #2 received
Received 02 Dec, 2019
Editor assigned
On 28 Nov, 2019
Reviewers invited
Invitations sent on 28 Nov, 2019
Reviewer #1 agreed
On 28 Nov, 2019
Submission checks complete
On 27 Nov, 2019
Editor invited
On 27 Nov, 2019
No comments provided
Editorial decision: Major revision
On 06 Nov, 2019
Review #2 received
Received 25 Oct, 2019
Reviewer #2 agreed
On 02 Oct, 2019
Review #1 received
Received 18 Jul, 2019
Reviewer #1 agreed
On 08 Jul, 2019
Reviewers invited
Invitations sent on 06 Jul, 2019
Submission checks complete
On 18 Jun, 2019
Editor invited
On 13 Jun, 2019
Editor assigned
On 13 Jun, 2019
First submitted
On 11 Jun, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Health Services Research.
Background. The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update. Methods. We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015). Results. Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals CI: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points 95%CI: -2.9, 0.2, p < 0.1, after multivariable adjustment. Conclusions. We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.
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