MP32-07 ASSOCIATION BETWEEN HOSPITAL ACCOUNTABLE CARE ORGANIZATION STATUS AND READMISSION FOLLOWING CYSTECTOMY AND OTHER MAJOR SURGERY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures II1 Apr 2017MP32-07 ASSOCIATION BETWEEN HOSPITAL ACCOUNTABLE CARE ORGANIZATION STATUS AND READMISSION FOLLOWING CYSTECTOMY AND OTHER MAJOR SURGERY Tudor Borza, Mary K. Oerline, Ted A. Skolarus, Bruce L. Jacobs, Amy N. Luckebaugh, Matthew Lee, Rita Jen, John M. Hollingsworth, Vahakn B. Shahinian, and Brent K. Hollenbeck Tudor BorzaTudor Borza More articles by this author , Mary K. OerlineMary K. Oerline More articles by this author , Ted A. SkolarusTed A. Skolarus More articles by this author , Bruce L. JacobsBruce L. Jacobs More articles by this author , Amy N. LuckebaughAmy N. Luckebaugh More articles by this author , Matthew LeeMatthew Lee More articles by this author , Rita JenRita Jen More articles by this author , John M. HollingsworthJohn M. Hollingsworth More articles by this author , Vahakn B. ShahinianVahakn B. Shahinian More articles by this author , and Brent K. HollenbeckBrent K. Hollenbeck More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.982AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Readmissions after surgery lead to low value care (worse outcomes and increased costs). Accountable care organizations (ACO) are doubly incentivized to reduce readmissions through receipt of shared savings bonuses by meeting benchmarks and avoidance of penalties from readmission reduction policies. Our objective was to determine the effect of Medicare Shared Savings Program (MSSP) ACOs on readmission rates after major surgery with a focus on cystectomy. METHODS We linked a 20% Medicare sample to Leavitt Partners ACO Data and performed a retrospective cohort study of patients undergoing major surgery (cystectomy, abdominal aortic aneurysm (AAA) repair, colectomy, total knee replacement, total hip replacement, lung resection) from 2010 to 2014. We stratified hospitals by MSSP ACO participation and calculated hospital level adjusted readmission and mortality rates using multivariable logistic regression models accounting for clustering within hospitals and procedures. We then performed a difference-in-differences analysis to determine the impact of ACO participation on readmission after major surgery, procedure specific readmissions and mortality rates. We compared outcomes in the pre-implementation and post-implementation periods. RESULTS We identified 388,003 patients of whom 61,938 (16%) underwent surgery in an ACO hospital. Overall, 60% were treated in the pre-implementation period. We noted significant secular trends in the non-ACO group from pre- to post-implementation in overall readmission rate (11.0% relative decrease, p<0.001) and mortality (11.1% relative decrease, p<0.001). ACO participation had a significant effect on readmission rate, accounting for an added 7.4% relative decrease, but no effect on mortality rate (Figure A, C; difference-in-differences estimator p=0.024, p=0.25, respectively). Trends for cystectomy were not significant for readmission (Figure B) or mortality in either group. CONCLUSIONS The overall readmission and mortality rates after major surgery decreased significantly between 2010 and 2014. ACOs accounted for an additional 7.4% reduction in overall readmission rates. Our findings demonstrate a synergistic effect of ACO participation and national readmission policy on readmissions after major surgery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e410-e411 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Tudor Borza More articles by this author Mary K. Oerline More articles by this author Ted A. Skolarus More articles by this author Bruce L. Jacobs More articles by this author Amy N. Luckebaugh More articles by this author Matthew Lee More articles by this author Rita Jen More articles by this author John M. Hollingsworth More articles by this author Vahakn B. Shahinian More articles by this author Brent K. Hollenbeck More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...