Professional Reimbursements in Maxillofacial Trauma: Effect of the Affordable Care Act

Purpose: Surgical treatment of maxillofacial injuries has historically been associated with low reimbursement rates, mainly due to the relatively high proportion of patients who are uninsured.¹ An exacerbating factor has been the increase in the number of uninsured individuals in the United States, from 43.5 million in 2007 to 47.3 million in 2012.² The Affordable Care Act (ACA), which was implemented on January 1, 2014, was designed with the goal of reducing the number of uninsured individuals. If the ACA achieves its goal, maxillofacial trauma surgeons may benefit from improved reimbursement rates, as the proportion of their patients who are uninsured decreases. Our purpose was to evaluate the effect of the ACA on payor distribution and reimbursement rates for the surgical treatment of maxillofacial trauma at our institution.

Methods: A review of all consecutive patients undergoing surgery for maxillofacial trauma at our institution over a 3-year period (January 2012 to December 2014) was conducted. Prisoners were excluded. Insurance status, amount billed and amount collected were recorded by procedure, payor and time period. Reimbursement rate, defined as amount collected divided by amount billed, was calculated. Patients treated before implementation of the ACA were compared to patients treated after the ACA.

Results: A total of 523 patients were analyzed. 334 patients underwent surgery in the two years before the ACA, and 189 patients underwent surgery after. Throughout the two time periods, the payor with the highest reimbursement rate was workers compensation (34.1%), followed by private insurance (20.6%), Medicare (18.2%), Medicaid (9.8%) and uninsured patients (0.2%). After the implementation of the ACA, the proportion of patients who were uninsured decreased significantly (27.2% to 11.1%, p<0.001), and the proportion of patients covered by Medicaid increased significantly (7.8% to 25.4%, p<0.001). The overall reimbursement rate did not change significantly between the two time periods (20.8% to 21.5%, p=0.5)

Conclusion: The implementation of the affordable care act resulted in a significant reduction in the proportion of patients with maxillofacial trauma who were uninsured, and in a significant increase in those who were covered by Medicaid. Overall, the reimbursement rate did not change after the implementation of the ACA. These trends should be followed over a longer term in order to determine the full effect of the ACA.