The Journal of Bone and Joint Surgery published an article on the impact the Massachusetts healthcare reform law, which went into effect four years before the ACA, had on spine surgery patient and payer mix.
Researchers used the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes to gather information on spine surgery patients from 2001 to 2012. There were 81,821 spine surgeries performed in Massachusetts over that time and 248,757 in New York, which the researchers used as a control group.
Study authors found:
1. The Massachusetts healthcare reform law was implemented in 2006, and after 2008 the state reported a decrease in spine surgeries for patients without insurance and those with private insurance. There was a decrease in surgeries for 18-year-olds to 44-year-olds.
2. After 2008, there was an increase in the number of spine surgeries for Medicare patients and those considered in the "other" insurance category. As a result, there was an increase in the number of surgeries for patients aged 65 years old to 84 years old.
3. The New York data showed increases in the number of spine surgeries performed for all insurance categories and age groups.
4. Even though younger patients had greater access to health insurance in Massachusetts, the data shows the number of young people undergoing surgery decreased. "In a healthcare system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly population," the study authors concluded.
5. Study authors also concluded, "The Massachusetts model continues to show that this type of policy is not causing extreme shifts in the payer mix, and suggests that spine surgery will continue to thrive in the current U.S. healthcare system."