PD25-11 EARLY IMPACT OF MEDICARE ACCOUNTABLE CARE ORGANIZATIONS ON UROLOGICAL CANCER OUTCOMES

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures I1 Apr 2016PD25-11 EARLY IMPACT OF MEDICARE ACCOUNTABLE CARE ORGANIZATIONS ON UROLOGICAL CANCER OUTCOMES Lindsey Herrel, Scott Hawken, Zaojun Ye, Edward Norton, and David Miller Lindsey HerrelLindsey Herrel More articles by this author , Scott HawkenScott Hawken More articles by this author , Zaojun YeZaojun Ye More articles by this author , Edward NortonEdward Norton More articles by this author , and David MillerDavid Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.241AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs) have expanded rapidly, it remains unknown whether hospital participation in this program has any impact on outcomes for surgical patients. To assess this question early in the ACO experience, we evaluated rates of adverse perioperative outcomes for patients undergoing urological cancer surgery in MSSP ACO participating hospitals compared to non-participating hospitals over the pre- and post-ACO period. METHODS Using national Medicare claims, we identified patients >65 years of age undergoing prostatectomy, nephrectomy or cystectomy between 2011 and 2013. Our primary outcomes were risk-adjusted rates of 30-day mortality, operative complications, readmissions, and prolonged LOS (procedure specific LOS >90th percentile). Using January 1, 2013 to define the pre- and post-ACO eras for non-participating control hospitals, we performed a difference-in-differences analysis to assess the impact of hospital MSSP ACO participation on each of these perioperative outcomes. RESULTS Among 129,159 Medicare beneficiaries undergoing urological cancer surgery during the study interval, we identified an overall 30-day mortality rate of 1.1%, readmission rate of 9.4%, complication rate of 30.2% and prolonged LOS rate of 9.6%. Hospital ACO participation was associated with a 15.8%, 7.5%, 3.7%, and 1.4% reduction in mortality, readmissions, complications, and prolonged LOS respectively; however, these changes attributable to ACO participation were not statistically significant reductions (all difference-in-differences estimators p-values>0.3, Figure). For individual procedures, patients undergoing prostatectomy and nephrectomy at control hospitals in the post-ACO era had an 11.2% (p<0.001) and 6.41% (p=0.016) reduction in the rate of prolonged LOS compared to the pre-ACO era, while all other outcomes measures remained unchanged. CONCLUSIONS Although longer follow-up is needed, hospital participation in the MSSP ACO program was not associated with reductions in adverse perioperative outcomes for patients undergoing urological cancer surgery in the early enrollment period. The observed improvements over time may reflect the impact of concurrent policies more directly applicable to surgical patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e592 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Lindsey Herrel More articles by this author Scott Hawken More articles by this author Zaojun Ye More articles by this author Edward Norton More articles by this author David Miller More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...