Introduction: Heart failure (HF) readmissions have been associated with lack of access to care, including health insurance and affordability. The focus of the Affordable Care Act (ACA) was to reduce cost as a barrier to care. Monitoring the trends in readmission rates is an important measure of patient care outcomes.
Hypothesis: The ability of receiving health care based on insurability will reduce the burden of heart failure readmissions through the measures implemented during the ACA.
Methods: Descriptive and multivariate analyses were performed utilizing the Healthcare Cost and Utilization Project (HCUP) on-line National Inpatient Readmission database to compare the 2009 and the 2013 hospital readmissions for HF.
Results: The study cohort consisted of weighted national estimates of 81,780 HF readmissions for 2009 compared to 65,458 HF readmissions in 2013. Overall readmissions declined by 20% (CI ± 0.038). Individuals that were uninsured had the least decline at 5.6% (CI ± 0.47) and those on Medicaid at 14% (CI ± 0.13). The highest percentage (39.8% (CI ± 0.11)) of individuals with the least readmission rates were those with private insurance coverage. Individuals (27.8% (CI ± 0.08)) who lived in non-metropolitan areas had a decrease in readmissions. Patients with a median income in the first quartile (1-39,000 U.S dollars) (lowest median income based on zip-code) had the most decline in readmissions for all quartiles. However, the overall cost of being readmitted for HF increased by 14% (CI ± 0.011) with the highest increase found in the age-group 18-44 ((27%) CI ± 0.067). Medicaid recipients had the highest cost expenditure increase for readmission at 19.5% (CI ± 0.09).
Conclusion: Inflation adjusted charges increased while hospital readmissions decreased between 2009 and 2013 among patients with HF. Hospitals’ care delivery systems started receiving financial incentives provided by the ACA in 2013. The observed decrease in readmission rates for HF in 2013 compared to 2009 may serve as a marker of reduced barrier to care in relation to increased insurance coverage and Medicaid expansion.