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The Impact of State Level Voting Trends, Medicare Expansion Laws, and Hospital Price Transparency On Cost of Distal Radius Fracture Management
Travis Kotzur, BS1, Aaron Singh, BA1, Jordan Carter, MD1, Ralph Zachary Garza, MD2 and Christina Brady, MD2, (1)UT Health San Antonio, San Antonio, TX, (2)Audie L. Murphy Memorial Veterans' Hospital, San Antonio, TX

Introduction: In the past several years, a number of pieces of legislation, including the Hospital Price Transparency Rule and various Medicare expansion acts, have been passed, both at the state and national level. The aim of this study is to assess the impact of partisan voting trends, transparency act legislation, and Medicare expansion on the cost of care in the setting of open reduction and internal fixation for distal radius fractures.
Materials and Methods: Turquoise Health, a database consisting of pricing information from hospitals across the country, was queried to identify the cost of ORIF for distal radius fractures. A number of variables, including the Cook Partisan Voting Index (CPVI), the passage of price transparency legislation, and Medicare expansion, were assessed via gamma regression analysis to determine their impact on cost for both Medicare and commercially insured patients. Hospital variables such as size, ownership, location, and CMS information were used as control variables.

Results: For Medicare, a Democrat CPVI (CPVI of +11D or more) was associated with a 52.7% increase in cost compared to a Moderate CPVI (CPVI +3R to +3D) (p<0.001), Medicare expansion had no impact on cost, while Transparency Act legislation was associated with a 11.9% increase (p<0.001). For commercial insurance, Transparency Act legislation was associated with a 16.5% increase (p<0.001), Medicare expansion was associated with a 19.1% increase (p<0.001), while a Republican CPVI (CPVI of +11R or more) compared to a Moderate CPVI was associated with a 84.9% increase (p<0.001).

Conclusion: Legislation and partisan voting trends appear to influence cost. Notably, price transparency legislation is associated with cost increases. As healthcare costs continue to climb, further research on the impact of legislation is warranted.

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