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The Affordable Care Act's Payment Reforms and the Future of HospitalsThe Affordable Care Act's Payment Reforms

Andrew M. Ryan, PhD; and Alvin I. Mushlin, MD, ScM
[+] Article, Author, and Disclosure Information

From Weill Cornell Medical College, New York, New York.

Grant Support: Dr. Ryan is supported by a grant from the Agency for Healthcare Research and Quality (K01 HS018546-01).

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2033.

Requests for Single Reprints: Andrew M. Ryan, PhD, Department of Healthcare Policy and Research, Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065; e-mail, amr2015@med.cornell.edu.

Current Author Addresses: Drs. Ryan and Mushlin: Department of Healthcare Policy and Research, Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065.

Author Contributions: Conception and design: A. Ryan, A. Mushlin.

Analysis and interpretation of the data: A. Ryan, A. Mushlin.

Drafting of the article: A. Ryan, A. Mushlin.

Critical revision of the article for important intellectual content: A. Ryan, A. Mushlin.

Final approval of the article: A. Ryan, A. Mushlin.

Obtaining of funding: A. Ryan.

Collection and assembly of data: A. Ryan.

Ann Intern Med. 2014;160(10):729-730. doi:10.7326/M13-2033
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Hospitals have remained consistent in their share of health care expenditures despite dramatic changes in the payment and financing of care, including the passage of the Patient Protection and Affordable Care Act. This commentary discusses how they have done this and what it portends for health care reform.

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Appendix Figure.

Hospital spending, 1960–2009.

Authors’ analysis using data from the Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. Adjusted for inflation and shown in 2005 U.S. dollars.

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Medicare inpatient and outpatient institutional spending, 2000–2010.

Authors’ analysis using data from Medicare Annual Beneficiary Summary Files, 2000–2010. Analysis excludes patients enrolled in Medicare Part A for fewer than 12 mo or those enrolled in any HMO plan. Adjusted for inflation and shown in 2005 U.S. dollars. Includes spending from hospitals and other institutional providers (for example, rural and federally qualified health centers), although more than 95% of spending was from hospital outpatient departments.

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