New research highlights consequences of ACA—both positive and negative

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 - Daniel Allar column mug

Two presentations at the American Heart Association’s scientific sessions in Anaheim, California, highlighted ways in which the Affordable Care Act (ACA) has changed the healthcare experience for patients—one good, one not so good.

Let’s start with the positive.

A combination of two studies demonstrated that more than three-fourths of patients without health insurance who were hospitalized for heart attack, stroke or coronary artery bypass graft (CABG) surgery incurred catastrophic medical expenses, defined as more than 40 percent of annual income after accounting for food costs. CABG patients incurred the highest costs ($85,891 to $177,546) and 83 percent of them exceeded the catastrophic expenses threshold, while 85 percent of heart attack patients and 75 percent of stroke patients surpassed that threshold.

Importantly, this data was collected before the passage of the ACA, and one of the studies’ lead authors pointed out the number of uninsured people at risk for catastrophic healthcare expenses has likely declined as a result of the legislation.

However, one unintended consequence of the ACA is troubling. The Hospital Readmissions Reduction Program (HRRP), implemented as part of the ACA, appears to have incentivized readmission reductions at the expense of patient safety, according to another recently published study.

While 30-day and one-year readmission rates dropped by 1.6 and 0.9 percent, respectively, after HRRP financial penalties were assessed, risk-adjusted mortality rates increased—from 7.2 percent to 8.6 percent at 30 days and from 31.3 to 36.3 percent at one year.

“Incentives to reduce readmissions can potentially encourage inappropriate care strategies, such as discouraging appropriate triage for emergency care, delaying hospital readmissions beyond discharge day 30, or increasing observation stays without admitting patients,” wrote lead researcher Ankur Gupta, MD, PhD, of Harvard Medical School, and colleagues in JAMA Cardiology.

Regardless of your political leanings, the lessons from these studies will be important to consider when conversations about U.S. healthcare policy reform inevitably ramp up again.

Of course, it’s easier to highlight a problem than to design (and pass) a cost-effective policy to fix it, but Gupta et al. offered a starting point that makes sense.

“Our study is … a reminder that, like drugs and devices, public health policies should be tested in a rigorous fashion—most preferably in randomized trials—before their widespread adoption,” they wrote.