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The Impact of The Affordable Care Act on Payor Mix in an Academic Plastic Surgery Center
Priya Lewis, BA, Emily Kutzner, BA, Nataliya Biskup, MD, Subhas Gupta, MD, PhD.
Loma Linda University Medical Center, Loma Linda, CA, USA.

PURPOSE:
Traditionally, the percentage of plastic surgery charges covered by self-pay funding has been relatively high, in academic plastic surgery. Various reports have listed the uninsured population in California extending as high as 21.2%. On January 1, 2014, the Affordable Care Act (ACA) began providing coverage to a number of previously uninsured individuals. This study seeks to determine whether or not implementation of the ACA has impacted the payor composition of plastic surgery patients.
METHODS:
We collected plastic surgery billing information for the first six months of 2013 and 2014. The monthly proportions of charges covered by self-pay in 2013 were calculated and compared side-by-side with the monthly proportions covered in 2014, using a paired t-test. As cosmetic procedures are generally not considered eligible for insurance coverage, we removed these procedures from the total self-pay charges when we performed our calculations.
RESULTS:
This study revealed a significant decrease in non-cosmetic self-pay charges from 2013 to 2014 (p value<0.0005).
CONCLUSION:
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These data suggest that the ACA has had an immediate, significant impact on this practice’s payor composition since its implementation. Our future research will focus on determining whether actual payments made on these charges have increased or decreased, as potential variations of this nature could affect the finances of plastic surgery practices across the nation.


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