MP9-18 ANTICIPATING THE IMPACT OF ACCOUNTABLE CARE ORGANIZATIONS ON THE COST AND QUALITY OF UROLOGIC CANCER CARE

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 2015MP9-18 ANTICIPATING THE IMPACT OF ACCOUNTABLE CARE ORGANIZATIONS ON THE COST AND QUALITY OF UROLOGIC CANCER CARE Lindsey Herrel, Scott Hawken, Chandy Ellimoottil, Zachary Montgomery, Zaojun Ye, and David Miller Lindsey HerrelLindsey Herrel More articles by this author , Scott HawkenScott Hawken More articles by this author , Chandy EllimoottilChandy Ellimoottil More articles by this author , Zachary MontgomeryZachary Montgomery More articles by this author , Zaojun YeZaojun Ye More articles by this author , and David MillerDavid Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.378AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many believe that Accountable Care Organizations (ACOs) will lead to higher quality and lower cost healthcare, including for specialty care like urology. In this context, we examined baseline outcomes and costs of inpatient urologic cancer surgery at hospitals that joined Medicare ACO programs compared with similar hospitals that are not participating. METHODS We used the Nationwide Inpatient Sample and American Hospital Association Survey to conduct a retrospective cohort study of patients undergoing inpatient urologic cancer surgery at ACO participating hospitals and non-ACO participating hospitals from 2007 through 2011. Hospitals participating in an ACO were identified from the Center for Medicare and Medicaid Services website as of February 2014. Propensity matching based on hospital structural characteristics was performed to identify non-participating hospitals from states with <6% of lives covered in an ACO. For three urologic cancer operations (prostatectomy, nephrectomy, cystectomy) we fit multivariable models to compare in-hospital mortality, prolonged length of stay (LOS, >90th percentile), and total hospital costs for patients treated at ACO and non-ACO participating hospitals. RESULTS Propensity matching identified 352 non-ACO hospitals to compare with 176 ACO participating hospitals. In multivariable analyses, neither mortality nor prolonged LOS differed according to ACO participation. Total hospitals costs were also similar for patients undergoing prostatectomy, nephrectomy and cystectomy at ACO participant versus non-participant hospitals (Figure). CONCLUSIONS Prior to implementation of Accountable Care Organizations, hospitals that now participate in these programs had similar rates of in-hospital mortality, prolonged LOS, and cost for inpatient urologic cancer care compared with hospitals that are not participating. Future studies will determine whether ACO participation meets the high expectations for higher quality and lower cost care in urology and other specialities. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e108-e109 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lindsey Herrel More articles by this author Scott Hawken More articles by this author Chandy Ellimoottil More articles by this author Zachary Montgomery More articles by this author Zaojun Ye More articles by this author David Miller More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...