PURPOSE: Because proposed funding cuts in the Affordable Care Act may impact care for urological patients at safety-net hospitals, we examined utilization, outcomes and costs of inpatient urological surgery at safety-net vs non-safety-net facilities prior to healthcare reform.
MATERIALS AND METHODS: Using the Nationwide Inpatient Sample, we performed a retrospective cohort study of patients undergoing inpatient urological surgeries from 2007 through 2011. We defined the "safety-net burden" of each hospital based on the proportion of Medicaid and self-pay discharges. We examined the distribution of urologic procedures performed, and compared in-hospital mortality, prolonged length of stay and costs in the highest quartile of burden (safety-net) vs lowest quartile (non-safety-net).
RESULTS: The distribution of urological procedures differs by safety-net status, with less benign prostate (9.1% safety-net vs 11.4% non-safety-net) and major cancer surgery (26.9% vs 34.3%), and more reconstructive surgery (8.1% vs 5.5%) at safety-net facilities (p-values< 0.001). Higher mortality at safety-net hospitals was seen for nephrectomy (OR 1.68, 95% CI 1.15-2.45) and TURP (OR 2.17, 95% CI 1.22-3.87). Patients in safety-net hospitals demonstrated greater prolonged LOS after endoscopic stone surgery (OR 1.20, 95% CI 1.01-1.41). Costs were similar across procedures except radical prostatectomy and cystectomy, where the average admission was more expensive at non-safety-net facilities (prostatectomy $9,610 vs $11,457 and cystectomy $24,048 vs $27,875, p-values < 0.02).
CONCLUSIONS: Reductions in funding to safety-net hospitals with healthcare reform could adversely impact access to care for patients with a broad range of urological conditions, potentially exacerbating existing disparities for vulnerable populations served by these facilities
Written by:
Herrel LA, Ye Z, Miller DC. Are you the author?
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
Reference: J Urol. 2015 Apr 29. pii: S0022-5347(15)03898-7.
doi: 10.1016/j.juro.2015.04.098
PubMed Abstract
PMID: 25936866