336 SHIFTING INPATIENT TO OUTPATIENT CARE FOR PROSTATE CANCER

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2010336 SHIFTING INPATIENT TO OUTPATIENT CARE FOR PROSTATE CANCER Sean Zhang, Ted Skolarus, and Brent Hollenbeck Sean ZhangSean Zhang More articles by this author , Ted SkolarusTed Skolarus More articles by this author , and Brent HollenbeckBrent Hollenbeck More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.402AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer spending accounts for approximately $7 billion in national health expenditures annually and continually outpaces the growth of GDP. Changes in payment mechanisms, inpatient care patterns, and an abundance of new technologies in the outpatient setting may have shifted spending patterns harboring important implications for how best to address future prostate cancer spending growth. In this context, we investigated the trends in Medicare expenditures for prostate cancer care. METHODS We identified 111,711 patients diagnosed with prostate cancer and sorted them into 144 cohorts based on their month of diagnosis from January 1992 through December 2003 using SEER-Medicare data. All Medicare payments for prostate cancer-related care were tallied and adjusted for inpatient, outpatient institutional, physician services, home health and hospice care for the first 2 years following diagnosis. Using a differencing method, we estimated the contributions of price and quantity to variations in per capita Medicare expenditures for the first 2 years of prostate cancer care. RESULTS Over the study period, per capita Medicare expenditures for the first 2 years of care increased 20% from $8,933 to $10,734 (Figure). A 57% decrease in per capita inpatient (Part A) Medicare expenditures ($3,499 to $1,500), was largely offset by spending growth in physician services (83%, $3,317 to $6,062) and outpatient institutional care (62%, $1,847 to $2,996). Increases in outpatient spending (Part B) were primarily attributed to increases in the quantity of both physician and outpatient institutional services, rather than price. CONCLUSIONS Overall, Medicare is spending more during the first 2 years following diagnosis for beneficiaries with prostate cancer. Instead of inpatient care, physician services are now the primary cost driver of Medicare expenditures for prostate cancer. Although prospective payment systems for inpatient (DRGs) and outpatient institutional care (APCs) may have impacted their respective domains, no such mechanism exists for physician services to control spending growth. Ann Arbor, MI© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e133-e134 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean Zhang More articles by this author Ted Skolarus More articles by this author Brent Hollenbeck More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...