Association of Health Professional Shortage Area Hospital Designation with Surgical Outcomes and Expenditure among Medicare Beneficiaries

Abstract

INTRODUCTION: More than a quarter of Americans live in federally designated Health Professional Shortage Areas. While there is growing concern that medical outcomes may be suboptimal in these areas, far less is known about surgical care. The objectives of this study were to compare surgical outcomes and Medicare payments at hospitals located in Health Professional Shortage Areas with nonshortage designated hospitals. METHODS: This was a cross-sectional retrospective study from 2014 to 2018 of 842,787 Medicare beneficiary patient admissions at hospitals with and without Health Professional Shortage Area designations for common operations including appendectomy, cholecystectomy, colectomy, and incisional hernia repair. Risk-adjusted outcomes using multivariable logistic regression accounting for patient factors and admission type were compared for each of the 4 operations at shortage vs nonshortage hospitals. Expenditure was compared based on total payment for each 30-day surgical episode including index hospitalization, physician services, readmission, and post-acute care payment for each study patient. RESULTS: Patients undergoing operation at Health Professional Shortage Area hospitals overall had lower risk-adjusted rate of 30-day mortality (6.05% vs 6.69%, odds ratio [OR] = 0.90, CI 0.90 to 0.91, p < 0.001) and readmission (14.99% vs 15.74%, OR = 0.94, CI = 0.94 to 0.95, p < 0.001). Risk-adjusted, price-standardized Medicare expenditure at Health Professional Shortage Area hospitals was also lower than nonshortage designated hospitals ($28,517 vs $29,685, difference in payment of −$1,168, p < 0.001) . CONCLUSION: Facilities located in Health Professional Shortage Areas provide safe care for common surgical procedures without evidence of higher expenditure for Medicare beneficiaries. These findings support current legislative proposals to increase funding for care in these underserved communities.