PD67-03 MEDICARE ACCOUNTABLE CARE ORGANIZATIONS REDUCE SPENDING ON UROLOGICAL SURGERY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures II (PD67)1 Apr 2019PD67-03 MEDICARE ACCOUNTABLE CARE ORGANIZATIONS REDUCE SPENDING ON UROLOGICAL SURGERY Parth K. Modi*, Nicholas M. Moloci, Lindsey A. Herrel, Brent K. Hollenbeck, Andrew M. Ryan, and John M. Hollingsworth Parth K. Modi*Parth K. Modi* More articles by this author , Nicholas M. MolociNicholas M. Moloci More articles by this author , Lindsey A. HerrelLindsey A. Herrel More articles by this author , Brent K. HollenbeckBrent K. Hollenbeck More articles by this author , Andrew M. RyanAndrew M. Ryan More articles by this author , and John M. HollingsworthJohn M. Hollingsworth More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557477.77527.4fAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Surgical care makes an outsized contribution to Medicare payments, accounting for more than half of program spending (∼$120 billion per year). Many hope that the collective incentives of Medicare accountable care organizations (ACOs) will help lower expenditures on surgery. However, the impact that ACO policy has had on surgical care remains unclear. METHODS: We analyzed a 20% sample of national Medicare data (2012 to 2015), identifying fee-for-service beneficiaries who were aligned and unaligned with a Shared Savings Program ACO. For each beneficiary, we then calculated total price-standardized annual payments made on his behalf for urologic procedures (based on Current Procedural Terminology codes 50000 to 55999). Using an interrupted time series research design, we then fit multivariable linear models, adjusting for age, gender, race, level of comorbid illness, socioeconomic status, and hospital referral region, to estimate the association between per beneficiary annual spending on urologic procedures and ACO status. Finally, we used multivariable negative binomial regression to determine whether the number of surgical episodes that a patient undergoes relates to his ACO status. RESULTS: We identified 19,065,107 beneficiary-year observations, 15.4% of which were aligned with an ACO. ACO alignment was associated with a savings on urologic surgery of $22 [95% confidence interval (CI), 15 to 29; P<0.001) per beneficiary-year (Table). This difference was driven by reduced spending on inpatient procedures (-$20; 95% CI, -$26 to -$13; P<0.001). While ACO alignment was not associated with a difference in the number of surgical episodes per beneficiary (relative rate, 0.99; 95% CI, 0.97 to 1.01; P=0.47), ACO-aligned beneficiaries underwent 5.8% fewer inpatient procedures than unaligned ones (0.94; 95% CI, 0.92 to 0.97; P<0.001). CONCLUSIONS: Medicare ACOs reduced spending per beneficiary per year on urologic care by $22. To provide perspective, if unaligned beneficiaries had a similar reduction, Medicare would have realized $416 million in savings over the study period. Spending reductions were driven, in part, by fewer inpatient surgical episodes. Source of Funding: This work was supported by AHRQ 1R01HS024525 01A1 and 1R01HS024728 01 (JMH), NCI F32CA232332 (PKM), NIA R01AG048071 (BKH) Ann Arbor, MI© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1199-e1199 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Parth K. Modi* More articles by this author Nicholas M. Moloci More articles by this author Lindsey A. Herrel More articles by this author Brent K. Hollenbeck More articles by this author Andrew M. Ryan More articles by this author John M. Hollingsworth More articles by this author Expand All Advertisement PDF downloadLoading ...