Patient Ambulatory Care Sensitive Care Condition Admissions by Insurance Type

It is often hypothesized that Medicaid patients have difficulty securing appointments with physicians for preventative care and treatment of minor illnesses. VHHA has tested this hypothesis. Our approach to evaluating that notion is to measure whether the rate of hospital admissions for ambulatory care sensitive conditions (ACSC) is greater among Medicaid patients than commercially insured patients. Ambulatory care sensitive conditions are medical problems often treated in non-acute settings, such as physician offices or clinics. A urinary tract infection is an example of a condition that can be treated outside a hospital. With proper medication and management through an ambulatory setting, many people seeking treatment do not require hospitalization. Other examples of common ACSCs include asthma, simple pneumonia, depression, bronchitis, and diabetes. However, barriers to accessing care exist. If, for instance, a medical practice limits its number of Medicaid patients or declines Medicaid patients due to the low reimbursement from the Virginia Department of Medical Assistive Services (DMAS), patients may have difficulty accessing timely primary care. To analyze this population, VHHA relied on a 2015 calendar year inpatient database with patients divided by payer groups. VHHA staff identified admissions for ACSCs using the Agency for Healthcare Research and Quality’s (AHRQ) list of ACSCs. The totals: 125,037 admissions for ACSCs among the Medicaid group, and 286,970 admissions of commercially insured patients. After adjusting for volume and variance, the results showed a statistically significant difference (p<.0001) between Medicaid ACSC hospitalizations and commercial ACSC hospitalizations. What that tells us is that being insured is not synonymous with having access to ambulatory care. When payment rates are below market values, patients have difficulty finding community providers to treat them. The resulting outcome is that hospitals are leaned on as ambulatory care providers of last resort. In these situations, hospitalizations tend to occur because previously untreated ACSC conditions become more serious and warrant inpatient care. This is a high cost to pay for lack of ambulatory care access. (10/7)