A groundbreaking study from EVMS has shed light on the crucial role of Medicaid Expansion (ME) in reducing 30-day hospital readmissions for major health conditions such as pneumonia, heart failure (HF), and acute myocardial infarction (AMI) — commonly known as a heart attack.

The study, published June 19, 2024, in the Journal of Hospital Medicine underscores the significant policy implications of ME and the potential for substantial healthcare cost savings and improved patient outcomes, says lead author Sami Tahhan, MD, Professor of Medicine.

Hospital readmissions within 30 days after discharge have garnered national policy attention due to their significant costs, accounting for over $17 billion in avoidable Medicare expenditures and being linked to poor health outcomes.

“Reducing these readmissions is essential not only to curb healthcare costs but also to enhance the quality of care and patient experience,” Dr. Tahhan says.

The Patient Protection and Affordable Care Act (ACA) of 2010 included critical measures aimed at broadening Medicaid eligibility, thus expanding coverage and access to healthcare for millions of low-income adults. Since January 1, 2014, several states have implemented Medicaid expansion, offering a pathway to coverage for a significant portion of the population. The ACA mandated the Centers for Medicare and Medicaid Services (CMS) to implement the Hospital Readmission Reduction Program (HRRP), which penalizes hospitals with higher-than-expected readmission rates.

While the HRRP’s impact on reducing readmissions has been extensively studied, the influence of ME on readmissions remained largely unknown until now.

The study analyzed data from 4,143 unique hospitals, with 51% located in ME-states. Non-ME states had a higher percentage of for-profit hospitals, hospitals in rural areas and nonteaching hospitals.

Prior to ME, unadjusted 30-day readmission rates were higher in ME-States than in non-ME States. However, following ME, there was a significant decrease in readmission rates for pneumonia, HF, and AMI across all states.

“Notably, the reductions were more pronounced in ME-States,” Dr. Tahhan says. “Even after adjusting for hospital and regional population characteristics, the reduction in readmission rates remained significant, highlighting the robustness of the findings.”

The study concluded that Medicaid expansion significantly contributes to reducing 30-day hospital readmissions, particularly for pneumonia, HF and AMI. This finding is critical, Dr. Tahhan says, as it underscores the importance of expanding healthcare access to improve patient outcomes and reduce healthcare costs. The data, which predates the COVID-19 pandemic, ensures that the results are not influenced by pandemic-related factors.

“Our findings demonstrate that expanding Medicaid not only broadens healthcare access but also substantially reduces the burden of hospital readmissions. This has profound implications for policymakers aiming to improve healthcare quality and reduce costs.”

The study’s large sample size, representative of U.S. hospitals, and meticulous adjustments for confounding factors make it a significant contribution to the ongoing discussion about healthcare policy and reform, Dr. Tahhan says. While limitations exist, such as the inability to draw patient-level conclusions, the study provides compelling evidence supporting the positive impact of Medicaid expansion on hospital readmissions.

EVMS co-authors of the study were Cynthia Avila, MBS, Research Manager in the Department of Medicine; Chloe Carr, MD, (MD ’23); and Rehan Qayyum, MD, the Harry H. Mansbach Chair in Internal Medicine and Professor and Chair of Internal Medicine.

(The chart at top shows a before and after comparison of pneumonia, heart failure and acute myocardial infarction (heart attack) 30-day risk-standardized readmission rates for hospitals located in Medicaid expansion states and non-Medicaid expansions states. Displayed results were adjusted for a range of factors.)