Abstract 236: Investigation of the Effects of the Affordable Care Act within the BRIDGE Population

Background: The U.S. Patient Protection and Affordable Care Act (ACA) aimed to provide all United States citizens access to health care and reform the way healthcare was delivered. A key provision of the ACA was the Readmission Reduction Program (RRP) that penalizes hospitals for excessive readmissions. This study sought to determine if changes exist after ACA implementation in demographics and outcomes of myocardial infarction (MI) and heart failure (CHF) patients referred for transitional care (BRIDGE). Methods: MI and CHF patients referred to BRIDGE between 2008-2016 were divided into pre-ACA (2008-2013) and post-ACA (2014-2016) cohorts. Demographics and outcomes (ED visits, readmissions) were compared between groups. Post-hoc, a subset of patients of low socioeconomic status (SES) were analyzed. Low SES was defined as a median household income (based on the patient’s zip code) less than the 2012 household income for the state of Michigan ($46,859). Results: Compared to pre-ACA patients, post-ACA patients had higher Charlson comorbidity scores and were more likely to be readmitted within 6-months. In addition, when examined independently, both MI and CHF patient subsets had higher Charlson scores post-ACA. Similar differences were seen in the subset of low SES patients, with post-ACA patients having higher Charlson scores, 6-month readmission rates, and 6-month ED visits rates than pre-ACA patients. Conclusions: There were few differences in outcomes between pre-ACA and post-ACA groups in this sample. Overall, post-ACA patients were sicker. There were no differences in participation in the BRIDGE transitional care program or in early readmissions or ED visits. Notably, there were higher rates of readmission and ED visits within 6-months, potentially suggesting greater access to care. This finding was consistent both in the total MI and CHF population as well as among those of low SES. More research is needed to determine whether changes as a result of ACA implementation can in part explain these findings.