Medical care
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Emergency department (ED) crowding is linked with poor quality of care and worse outcomes, including higher mortality. With the growing emphasis on hospital performance measures, there is additional concern whether inadequate care during crowded periods increases a patient's likelihood of subsequent inpatient admission. We sought to determine if ED crowding during the index visit was associated with these "bounceback" admissions. ⋯ Crowding as measured by ambulance diversion does not have an association with hospitalization within 7 days of an ED visit discharge. Therefore, bounceback admission may be a poor measure of delayed or worsened quality of care due to crowding.
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The Affordable Care Act enacted significant Medicare payment reductions to providers, yet the effects of such major reductions on patients remain unclear. We used the Balanced Budget Act (BBA) of 1997 as a natural experiment to study the long-term consequence of major payment reductions on patient outcomes. ⋯ We found consistent evidence across multiple conditions that reductions in Medicare payments are associated with slower improvement in mortality outcomes.
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The Patient Protection and Affordable Care Act will expand Medicaid coverage substantially, with the goal of improving the health of low-income individuals and reducing disparities in coverage and access. Whether insurance expansions are successful in achieving this goal will depend in part on physician response to changes in insurance coverage mix and the effect of this response on access to care for low-income safety net populations. ⋯ Past changes in Medicaid coverage rates are not associated with changes in physician acceptance of new Medicaid patients or provision of charity care, although they are associated with lower acceptance of new uninsured patients, particularly among office-based physicians.