62 Impact of the Affordable Care Act on Post-discharge Services After Burn Injury

Introduction Recovery from burn injury is a prolonged process often requiring post-discharge services such as rehabilitation or skilled nursing care. Affordable Care Act Open Enrollment (ACA-OE) began in January 2014 providing access to medical insurance for millions of previously uninsured Americans. Whether improved insurance coverage has improved access to post-discharge care for patients admitted with burn injury is unknown. We hypothesized that the ACA would improve insurance coverage for patients admitted with burn injury and that medical insurance would be associated with increased access to post-discharge care services. Methods The Nationwide Readmission Database was queried to identify patients ages 18–65 with an index admission for cutaneous burn injury using ICD-9 & ICD-10 codes. Patients with Medicare or those that died during the index admission were excluded. Pre-ACA-OE admissions (2013, Q1-Q3) were compared with post-ACA admissions (2016, Q1-Q3) to evaluate the effects the ACA-OE of insurance status, length of stay, discharge disposition, 30- and 90-day readmission rates. Results There were 12,932 burn-injured patients included with 5,389 patients in 2013 and 7,543 patients in 2016. Post-ACA, Medicaid insurance increased from 33.0% to 43.9% (p< 0.001) while self-pay decreased from 25.8% to 13.7% (p< 0.001). Private insurance status did not change after implementation of the ACA (41.2% vs. 42.4%). Post-ACA-OE, overall routine discharge home decreased from 79.4% to 77.7% (p=0.02) while discharge to a care facility increased from 7.2% to 8.7% (p=0.002). Length of stay was not different between groups (8.9 ± 15.9 days vs. 9.0 ± 15.5 days). Medicaid patients had the highest readmission rates at 30- and 90-days (see Figure). Medicaid patients had decreased 90-day non-elective readmission rates post-ACA-OE (22.4% to 20.0%, p=0.041). Predictors of non-elective 90-day readmission were Medicaid insurance (OR 2.06, CI 1.76–2.40, p< 0.001) and older age (OR 1.03, CI 1.02–1.03, p< 0.001). Conclusions The ACA-OE increased access to insurance for burn patients. Discharges to care facilities after burn injury increased post-ACA-OE and was associated with decreased 90-day readmission. Ongoing advocacy efforts are need to improve access to post-burn care resources to optimize recovery from injury. Applicability of Research to Practice Awareness of the impacts of health policy and insurance coverage on access to post-discharge resources and readmission rates after burn injury.