Table 1. Patient and Hospital Characteristics Before and After Passage of the Patient Protection and Affordable Care Acta.
| Characteristic | Prereform, January 2008-March 2010 | Postreform, April 2010-August 2015 | ||
|---|---|---|---|---|
| Critical access hospital (n = 102 564) | Acute care hospital (n = 2 278 544) | Critical access hospital (n = 210 2010 | Acute care hospital (n = 5 042 933) | |
| Age, mean (SD), y | 80.92 (8.07) | 79.24 (7.84) | 80.88 (8.26) | 79.25(8.07) |
| Women | 63 983 (62.4) | 1 354 053 (59.4) | 130 462 (62.1) | 2 977 132 (59.0) |
| White race | 96 612 (94.2) | 1 991 226 (87.4) | 198 260 (94.3) | 4 382 927 (86.9) |
| Prevalence of targeted conditions | ||||
| AMI | 863 (0.8) | 60 183 (2.6) | 1855 (0.9) | 137 877 (2.7) |
| Heart failure | 7306 (7.1) | 127 343 (5.6) | 14 325 (6.8) | 273 040 (5.4) |
| Pneumonia | 14 240 (13.9) | 130 912 (5.7) | 29 546 (14.1) | 278 637 (5.5) |
| 30-d readmission rate, mean (SD) | ||||
| All conditions | 13.98 (0.35) | 14.47 (0.35) | 13.08 (0.34) | 13.63 (0.34) |
| AMI | 17.50 (0.38) | 18.52 (0.39) | 15.58 (0.36) | 16.52 (0.37) |
| Heart failure | 19.92 (0.40) | 21.23 (0.41) | 17.28 (0.38) | 19.93 (0.40) |
| Pneumonia | 13.01 (0.34) | 15.35 (0.36) | 12.71 (0.33) | 14.45 (0.35) |
| HCC score, mean (SD) | 1.55 (1.05) | 1.57 (1.20) | 1.68 (1.17) | 1.76 (1.35) |
| DRG weight | 0.96 (0.45) | 1.49 (1.27) | 1.01 (0.50) | 1.55 (1.29) |
| Bed size | ||||
| <200 | 102 564 (100.0) | 687 139 (30.2) | 210 201 (100.0) | 1 499 995 (29.7) |
| 200-349 | 0 | 673 805 (29.6) | 0 | 1 453 347 (28.8) |
| 350-499 | 0 | 412 378 (18.1) | 0 | 902 060 (17.9) |
| ≥500 | 0 | 505 222 (22.2) | 0 | 1 187 531 (23.5) |
| Profit status | ||||
| For-profit | 5134 (5.0) | 329 469 (14.5) | 10 885 (5.2) | 797 392 (15.8) |
| Nonprofit | 59 416 (57.9) | 1 693 771 (74.3) | 124 808 (59.4) | 3 716 955 (73.7) |
| Other | 38 014 (37.1) | 255 304 (11.2) | 74 508 (35.4) | 528 586 (10.5) |
| Geographic region | ||||
| Midwest | 51 108 (49.8) | 571 034 (25.1) | 99 706 (47.4) | 1 227 230 (24.3) |
| Northeast | 8125 (7.9) | 468 614 (20.6) | 17 686 (8.4) | 1 019 524 (20.2) |
| South | 26 939 (26.3) | 905 995 (39.8) | 55 208 (26.3) | 2 021 241 (40.1) |
| West | 16 392 (16.0) | 332 901 (14.6) | 37 601 (17.9) | 774 938 (15.4) |
| Teaching hospitals | 0 | 391 315 (17.2) | 0 | 859 800 (17.0) |
| Urban location | 39 550 (38.6) | 2 213 243 (97.1) | 83 289 (39.6) | 4 922 828 (97.6) |
| Medicaid days, mean (SD), % | 18.27 (0.21) | 17.17 (0.10) | 17.55 (0.18) | 18.54 (0.10) |
| Medicare days, mean (SD), % | 54.10 (0.23) | 50.84 (0.12) | 55.59 (0.26) | 51.27 (0.12) |
Abbreviations: AMI, acute myocardial infarction; DRG, diagnosis-related group; HCC, hierarchical condition category.
a
Cohort size is based on episodes included in difference-in-differences analysis comparing acute care and critical access hospitals for all diagnoses.