The Affordable Care Act and its association with length of stay and payer status for trauma patients at a level I trauma center.

Background: We hypothesized that the ACA would shorten length of stay and increase numbers of insured patients without changing trauma patient outcomes. Methods: A retrospective review of adult trauma patients admitted to a level I trauma center between 2012 and 2014 was performed. Demographics, length of stay, payer status, discharge disposition, and complications before and after the ACA implementation were analyzed. Results: 4448 trauma patients were admitted during the study period. Patients treated after ACA implementation were older (53 vs 51, p = 0.05) with shorter ICU stays (1.7 vs 1.5 days, p = 0.04), but longer overall hospital stays (3.7 vs 4.1 days, p < 0.01). The proportion of self-pay patients decreased 11% -3% (p = < 0.001). A higher proportion of patients were discharged to skilled nursing facilities (SNF, 17.1% vs 19.9%, p = 0.02). There was no change in rates of death, readmission, infection, pneumonia or decubiti. Conclusion: Among trauma patients, there was a decrease in self-pay status and increase in public insurance without change in private insurance after implementation of the ACA. More patients were discharged to SNF without changes in reported outcomes. (C) 2017 Elsevier Inc. All rights reserved.