MP17-03 FACILITY-LEVEL FACTORS ASSOCIATED WITH DECREASING SHARE OF UROLOGIC CANCER PATIENTS WITH MEDICAID FOLLOWING IMPLEMENTATION OF THE AFFORDABLE CARE ACT

Abstract

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures I (MP17)1 Sep 2021MP17-03 FACILITY-LEVEL FACTORS ASSOCIATED WITH DECREASING SHARE OF UROLOGIC CANCER PATIENTS WITH MEDICAID FOLLOWING IMPLEMENTATION OF THE AFFORDABLE CARE ACT Patrick Demkowicz, Matthew Buck, James Nie, Victoria Marks, and Michael Leapman Patrick DemkowiczPatrick Demkowicz More articles by this author , Matthew BuckMatthew Buck More articles by this author , James NieJames Nie More articles by this author , Victoria MarksVictoria Marks More articles by this author , and Michael LeapmanMichael Leapman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002002.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although the Affordable Care Act (ACA) expanded access to Medicaid, some hospitals may limit Medicaid patients due to lower reimbursement. Our study aims to understand how the proportion of urologic cancer patients with Medicaid changed across Commission on Cancer (CoC) facilities following ACA implementation. METHODS: We analyzed data from the National Cancer Database, which includes patients diagnosed at CoC facilities in the United States. We grouped patients aged 18-64 years and diagnosed between 2010-2017 with urologic cancers (prostate, urinary/bladder, kidney/renal pelvis, testis and penis) into distinct, deidentified facilities. We restricted our sample to facilities diagnosing ≥10 patients/year and excluded facilities in states that expanded Medicaid early or late. The primary outcome was the mean facility-level change in proportion of urologic cancer patients with Medicaid after ACA implementation (Jan 1, 2014) stratified by state Medicaid expansion status. We used multivariable logistic regression to determine the baseline clinical and demographic factors associated with a decrease in the proportion of a facility’s patients carrying Medicaid. RESULTS: We identified 630 facilities (287 expansion and 343 non-expansion) treating 436,082 urologic cancer patients. The mean facility-level change in proportion of patients with Medicaid was +5.8% (95% CI 5.0-6.5%) in expansion states vs. +0.6% (95% CI 0.2-0.9%) in non-expansion states. Despite overall increases, 13.6% of facilities in expansion states and 40.8% in non-expansion states experienced reductions (p <0.001). Facility-level factors associated with a decreased proportion of patients with Medicaid included non-expansion status (OR 7.5, 95% CI 4.6-13, p <0.001), highest quartile baseline Medicaid coverage (OR 4.8, 95% CI 2.5-9.6, p <0.001) and highest quartile share of patients from zip codes with median household incomes ≥$63,000 (OR 3.3, 95% CI 1.6-6.7, p <0.001). CONCLUSIONS: Despite a national increase in Medicaid coverage after ACA implementation, a subset of CoC facilities saw relatively fewer Medicaid patients. These findings may reflect disparities among urologic cancer patients with Medicaid in their ability to receive care at the facilities of their choosing. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e308-e309 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Demkowicz More articles by this author Matthew Buck More articles by this author James Nie More articles by this author Victoria Marks More articles by this author Michael Leapman More articles by this author Expand All Advertisement Loading ...