Utilization of Left Ventricular Assist Devices in Vulnerable Adults Across Medicaid Expansion.

The Journal of Surgical Research
Afshin EhsanWaddah B Al-Refaie

Abstract

Continuous-flow left ventricular assist device (LVAD) implantation is a payor sensitive procedure influenced by preoperative comorbidities and social factors. Whether expansion in insurance coverage will further influence device utilization is unknown. This study sought to assess the effects of Medicaid expansion on vulnerable populations (namely racial-ethnic minorities and those with low-income status) undergoing continuous-flow LVAD implantation after the enactment of the 2014 Affordable Care Act (ACA). Data from the 2012 to Q3 2015 State Inpatient Database were used to examine a cohort of 624 nonelderly adults (aged 18-64 y) who were given a continuous-flow LVAD in three expansion states (Kentucky, New Jersey, and Maryland) and two nonexpansion states (North Carolina and Florida). The cohort excluded patients who had a heart transplant, heart-lung transplant, or noncontinuous-flow LVAD. Poisson Interrupted Time Series was used with three-way interactions and change of slope and intercept parameters at 2014 to determine the impact of the ACA expansion on utilization of continuous-flow LVAD by race and insurance strata. Poisson Interrupted Time Series models show that within expansion states, the population of Medicaid and un...Continue Reading

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Citations

Nov 15, 2020·The Annals of Thoracic Surgery·Afshin EhsanWaddah B Al-Refaie

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