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PURPOSE: Multiple studies have demonstrated limitations in access to specialized trauma care for uninsured patients. Some institutions have sought remedies to these limitations in access, such as adopting the policy of accepting all transfers for specialized trauma care. For instance, the Curtis National Hand Center (CNHC) accepts all transfer requests for hand trauma. However, this policy of universal transfer acceptance has encouraged unnecessary transfers and inappropriate indications for transfer, especially of uninsured patients. In this study, we evaluate if Medicaid expansion under the Affordable Care Act has decreased unnecessary transfers for lower-acuity care by reducing the prospect of uncompensated care provided at local hospitals.

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Abstract 01: Change in Payer Mix and Transfer Appropriateness at a Quaternary Hand Trauma Referral Center after Medicaid Expansion under the Affordable Care Act