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Changes in Hospital Uncompensated Care Following the Texas Medicaid Waiver Implementation

The Journal of Health Care Finance

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Title Changes in Hospital Uncompensated Care Following the Texas Medicaid Waiver Implementation
 
Creator Revere, PhD, Lee; Associate Professor and Program Director, Management, Policy and Community Health
Director of the Fleming Center for Healthcare Management
School of Public Health
University of Texas Health Science Center at Houston
Large, PhD, John; Affiliate Assistant Professor, Department of Health Policy & Management
College of Public Health
University of South Florida
Langland-Orban, PhD, Barbara; Professor and MHA Program Director, Department of Health Policy & Management
College of Public Health
University of South Florida
Zhang, MSPH, Hanze; Research Assistant, Department of Health Policy & Management
College of Public Health
University of South Florida
Delgado, PhD, Rigoberto; Associate Professor, Economics
College of Business Administration
University of Texas El Paso
Amadi, MS, Tochi; Graduate Student, Management, Policy and Community Health
School of Public Health
University of Texas Health Science Center at Houston
 
Description In 2011, Texas implemented an 1115 Medicaid Waiver in lieu of Medicaid expansion. This study assesses changes in hospital uncompensated care percentage (UCP) and measures the effect of the delivery system reform incentive payment (DSRIP) initiatives, using two payment variables (Category 1 and 2 payments and Category 3 payments) on UCP between 2012 and 2016. Data were obtained from the American Hospital Association for 2011 to 2016 and from Texas Health and Human Services for 2011 to 2015.  A mixed-effects model was used to estimate the association between DSRIP funding and changes in UCP the following year.  Independent variables included Fiscal Year, Bed Size, Underfunded Patient Mix, and DSRIP earned funding amounts.  The study found DSRIP funding for Category 3 (outcome-based measures) was significantly associated with decreased UCP. Category 1 and 2 payments, which primarily funded infrastructure, were not significant; however, they are necessary to achieve Category 3 outcomes. These results indicate UCP can be decreased through funding achievements in Category 3 outcomes. This is promising for CMS and Texas as Texas implements waiver 2.0, which is structured to pay for large-scale improvements in health outcomes.
 
Publisher Worldwebtalk.com, Inc.
 
Contributor
 
Date 2018-05-11
 
Type info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
Peer-reviewed Article
 
Format application/pdf
 
Identifier http://healthfinancejournal.com/index.php/johcf/article/view/149
 
Source Journal of Health Care Finance; Vol. 44, No. 3, WINTER 2018
 
Language eng
 
Relation http://healthfinancejournal.com/index.php/johcf/article/view/149/153
 
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