"Implications of the ACA on Critical Access Hospitals and Patients’ Res" by Rebecca Yant Kimmelmann

Date of Conferral

1-10-2025

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Services

Advisor

Sally Willis

Abstract

Critical access hospitals (CAHs) have a history of closing due to a lack of financial viability, causing U.S. communities to lose support provided from jobs and taxes paid by the hospital, and patients to lose health care access. With the implementation of the Affordable Care Act and Patient Protection Act of 2010 (ACA), the expectation was that more people would become insured, but plan copays and deductibles owed by patients increased. The purpose of this study, which was undergirded by von Bertalanffy’s general systems theory, was to explore (a) whether there was a significant correlation between the implementation of the ACA and an increase in patient-responsible balances as a percentage of gross charges and (b) whether the amount of patient-responsible balances written off as a percentage of gross charges increased. The data analyzed in this quantitative, correlational study were from a rural Alabama CAH and encompassed the years 2009 and 2019, amounting to 45,011 patient accounts. Using SPSS software, t-tests were performed to evaluate correlations, if any, between patient-responsible balances, balances written off, and gross charges. The analysis concluded that the patient-responsible balances and patient-responsible balance write-offs were significantly lower in 2019 when compared to 2009; t(45,009)=8.64, p=<.001, and t(45,009)=9.525, p=<.001 respectively. A recommendation for further research includes reviewing data by payor for negative trends. The finding that the ACA works at the focal CAH as intended may allow organizational leaders to concentrate on the revenue cycle process, contracts, and other expenses so they can remain financially viable to continue to promote community health.

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