Findings on Managed Care Reported by Investigators at University of Pennsylvania (Awaiting Insurance Coverage: Medicaid Enrollment and Post-acute Care Use After Traumatic Injury): Managed Care

2025 APR 01 (NewsRx) -- By a News Reporter-Staff News Editor at Hospital & Nursing Home Daily -- Research findings on Managed Care are discussed in a new report. According to news reporting originating in Philadelphia, Pennsylvania, by NewsRx journalists, research stated, “Lack of insurance after traumatic injury is associated with decreased use of postacute care and poor outcomes. Insurance linkage programs enroll eligible patients in Medicaid at the time of an unplanned admission.”

The news reporters obtained a quote from the research from the University of Pennsylvania, “We hypothesized that Medicaid enrollment would be associated with increased use of postacute care, but also with prolonged hospital length of stay (LOS) while awaiting insurance authorization. We linked trauma registry and EMR data to identify patients ages 18 years to 64 years admitted from 2017 to 2021 to a Level I trauma center. Patients admitted without insurance and retroactively insured (RI) during hospitalization were compared with patients with established Medicaid (MI) and those remaining uninsured (UI). We measured postacute care use including home health care, rehabilitation, and skilled nursing facilities. We tested the association between insurance status and discharge disposition and LOS (primary outcome) using multivariable negative binomial regression. Direct costs were compared between groups. We compared 494 RI patients to 1706 MI and 148 UI patients. Retroactively insured patients had longer hospitalization (median LOS [interquartile range], 4 days [2-9 days]) than other groups (MI, 4 [2-8] and UI 2 [1-3]), p< 0.001). Retroactively insured patients were more likely to be discharged with home health care and to inpatient rehabilitation than UI patients (p < 0.001). After adjusting for injury and management characteristics, RI was associated with longer LOS compared with MI for patients discharged to inpatient facilities (p < 0.001). Median costs for RI patients discharged to a facility were $10,284 higher than MI patients, ranging from $8,582 for Injury Severity Score <9 to $51,883 for Injury Severity Score >= 25. Enrollment in Medicaid after traumatic injury is associated with postacute care use, but the current enrollment process may delay discharge.”

According to the news reporters, the research concluded: “Streamlining insurance enrollment and permitting discharge with pending application status could reduce unnecessary hospital days, saving costs and improving improve patient experience.”

This research has been peer-reviewed.

For more information on this research see: Awaiting Insurance Coverage: Medicaid Enrollment and Post-acute Care Use After Traumatic Injury. Journal of Trauma and Acute Care Surgery, 2025;98(3):418-424. Journal of Trauma and Acute Care Surgery can be contacted at: Lippincott Williams & Wilkins, Two Commerce Sq, 2001 Market St, Philadelphia, PA 19103, USA. (Lippincott Williams and Wilkins - www.lww.com; Journal of Trauma and Acute Care Surgery - http://journals.lww.com/jtrauma/pages/default.aspx)

Our news correspondents report that additional information may be obtained by contacting Elinore J. Kaufman, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States. Additional authors for this research include Diane N. Haddad, Justin S. Hatchimonji, Ella C. Eisinger, Angela T. Chen, Omar I. Ramadan, Anna U. Morgan, M. Kit Delgado, Niels D. Martin, Mark J. Seamon, Kristen M. Chreiman and Lisa M. Knowlton.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1097/ta.0000000000004550. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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