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MP32-08 ACCOUNTABLE CARE ORGANIZATIONS AND THE USE OF PROSTATE CANCER SCREENING
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Saturday, May 13, 2017
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-indifferences estimator p¼0.024, p¼0.25, 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.
e411
CONCLUSIONS: The ACO model appears to have a salutary effect on preventive service utilization. Our findings vis-a-vis PCa-S among ACOs are likely a reflection of improved health care access rather than vetted screening practices. There is hope that such nonrecommended screening will decrease if more ACOs are required to move towards a “two-sided” risk shared savings and loss model.
Source of Funding: none Source of Funding: This work was supported by the American Cancer Society (RSG 12-323-01-CPHPS), the National Cancer Institute (R01 CA168691, R01 CA174768, T32 CA180984) and the National Institute on Aging (R01 AG048071).
MP32-08 ACCOUNTABLE CARE ORGANIZATIONS AND THE USE OF PROSTATE CANCER SCREENING Christian P. Meyer*, Anna Krasnova, Boston, MA; Jesse D. Sammon, Detroit, MI; Philipp Gild, Nicolas von Landenberg, Stuart R. Lipsitz, Joel S. Weissman, Boston, MA; Felix K. H. Chun, Margit Fisch, Hamburg, Germany; Maxine Sun, Quoc-Dien Trinh, Boston, MA INTRODUCTION AND OBJECTIVES: Accountable Care Organizations (ACOs) were established under the Affordable Care Act as a new payment model intended to impose greater responsibility on all stakeholders for cost control and quality improvement. Preventive services are an ideal target to monitor the effectiveness of new health care delivery models. We sought to examine and compare the prevalence of breast cancer screening (BCa-S), and prostate cancer screening (PCa-S) between ACO and traditional Medicare beneficiaries. We hypothesized that the use of BCa-S is higher among beneficiaries attributed to an ACO, whereas the use of PCa-S, a nonrecommended test, would be unaffected by ACO assignment. METHODS: Using a random 20% sample of Medicare beneficiaries, we assessed BCa-S in those aged <75, (evidence-based cancer screening), and PCa-S in those <75 (non-recommended cancer screening) between January 1, 2013 and December 31, 2013 with appropriate exclusion criteria. ACO coverage was ascertained from the quarterly assignment in the Shared Savings Program ACO Beneficiarylevel file. RESULTS: Following propensity-score weighting, our final cohorts of ACO and traditional Medicare beneficiaries included, 52,987/ 526,063 women for BCa-S, and 86,936/814,221 men for PCa-S, respectively. The prevalence of screening in ACO vs. traditional Medicare were 35.0% vs. 25.2% for BCa-S, and 54.6% vs. 41.7% for PCa-S (all p<.001).
MP32-09 PATIENTS RECEIVING VALUE-BASED CARE FOR BPH SURGERY DO NOT EXPERIENCE WORSE CLINICAL OUTCOMES Alan L Kaplan*, Vishnukamal Golla, Catherine M. Crespi, Jamal Nabhani, Mark S. Litwin, Christopher Saigal, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Recent policy changes encourage a transition toward value-based care. In 2014, we implemented value-based care redesign for patients undergoing surgery for uncomplicated BPH. We defined an optimal care pathway using outcomes and cost data, guideline recommendations, and patient input. Our pathway includes TURP or plasma vaporization without preoperative cystoscopy or urodynamics. In this study, we ask whether patients treated under a value-based care pathway experience worse outcomes. METHODS: We reviewed records of men undergoing an episode of BPH care between April 2014 and December 2015. Only those with UCLA HMO, ACO, or those having established PPO primary care at UCLA were included. Men with coexisting complicating urological conditions were excluded. The 5 outcomes examined were 1year reoperation, 90-day readmission, emergency department visit within 30 days, >3 clinic visits within 30 days, BPH prescription filled >30 days after surgery. Potential confounding variables included age, gland size, diabetes, neurologic disease, and preoperative catheter status. We used multivariable logistic regression to test the effect of surgery type and the use of preoperative invasive testing. RESULTS: There were 225 men with complete data. Fiftyseven men (23%) had diabetes and 73 (29%) used indwelling or intermittent catheter prior to surgery. TURP or plasma vaporizaton was performed in 187 (74%) patients and 145 (58%) underwent preoperative invasive testing (cystoscopy or urodynamics). Patients receiving preoperative invasive testing were more likely to have >3 clinic visits within 30 days (OR 3.7, p¼0.005); analyses entering cystoscopy and urodynamics as individual variables shows this attributable to cystoscopy (OR 3.1, p¼0.004). There were no other differences in outcomes among those receiving value-based care. Men with neurologic disease and those undergoing laser vaporization were more likely to fill a BPH medication prescription after surgery (OR 2.8, p¼0.009 and OR 2.5,
Vol. 197, No. 4S, Supplement, Saturday, May 13, 2017
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-indifferences estimator p¼0.024, p¼0.25, 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.
e411
CONCLUSIONS: The ACO model appears to have a salutary effect on preventive service utilization. Our findings vis-a-vis PCa-S among ACOs are likely a reflection of improved health care access rather than vetted screening practices. There is hope that such nonrecommended screening will decrease if more ACOs are required to move towards a “two-sided” risk shared savings and loss model.
Source of Funding: none Source of Funding: This work was supported by the American Cancer Society (RSG 12-323-01-CPHPS), the National Cancer Institute (R01 CA168691, R01 CA174768, T32 CA180984) and the National Institute on Aging (R01 AG048071).
MP32-08 ACCOUNTABLE CARE ORGANIZATIONS AND THE USE OF PROSTATE CANCER SCREENING Christian P. Meyer*, Anna Krasnova, Boston, MA; Jesse D. Sammon, Detroit, MI; Philipp Gild, Nicolas von Landenberg, Stuart R. Lipsitz, Joel S. Weissman, Boston, MA; Felix K. H. Chun, Margit Fisch, Hamburg, Germany; Maxine Sun, Quoc-Dien Trinh, Boston, MA INTRODUCTION AND OBJECTIVES: Accountable Care Organizations (ACOs) were established under the Affordable Care Act as a new payment model intended to impose greater responsibility on all stakeholders for cost control and quality improvement. Preventive services are an ideal target to monitor the effectiveness of new health care delivery models. We sought to examine and compare the prevalence of breast cancer screening (BCa-S), and prostate cancer screening (PCa-S) between ACO and traditional Medicare beneficiaries. We hypothesized that the use of BCa-S is higher among beneficiaries attributed to an ACO, whereas the use of PCa-S, a nonrecommended test, would be unaffected by ACO assignment. METHODS: Using a random 20% sample of Medicare beneficiaries, we assessed BCa-S in those aged <75, (evidence-based cancer screening), and PCa-S in those <75 (non-recommended cancer screening) between January 1, 2013 and December 31, 2013 with appropriate exclusion criteria. ACO coverage was ascertained from the quarterly assignment in the Shared Savings Program ACO Beneficiarylevel file. RESULTS: Following propensity-score weighting, our final cohorts of ACO and traditional Medicare beneficiaries included, 52,987/ 526,063 women for BCa-S, and 86,936/814,221 men for PCa-S, respectively. The prevalence of screening in ACO vs. traditional Medicare were 35.0% vs. 25.2% for BCa-S, and 54.6% vs. 41.7% for PCa-S (all p<.001).
MP32-09 PATIENTS RECEIVING VALUE-BASED CARE FOR BPH SURGERY DO NOT EXPERIENCE WORSE CLINICAL OUTCOMES Alan L Kaplan*, Vishnukamal Golla, Catherine M. Crespi, Jamal Nabhani, Mark S. Litwin, Christopher Saigal, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Recent policy changes encourage a transition toward value-based care. In 2014, we implemented value-based care redesign for patients undergoing surgery for uncomplicated BPH. We defined an optimal care pathway using outcomes and cost data, guideline recommendations, and patient input. Our pathway includes TURP or plasma vaporization without preoperative cystoscopy or urodynamics. In this study, we ask whether patients treated under a value-based care pathway experience worse outcomes. METHODS: We reviewed records of men undergoing an episode of BPH care between April 2014 and December 2015. Only those with UCLA HMO, ACO, or those having established PPO primary care at UCLA were included. Men with coexisting complicating urological conditions were excluded. The 5 outcomes examined were 1year reoperation, 90-day readmission, emergency department visit within 30 days, >3 clinic visits within 30 days, BPH prescription filled >30 days after surgery. Potential confounding variables included age, gland size, diabetes, neurologic disease, and preoperative catheter status. We used multivariable logistic regression to test the effect of surgery type and the use of preoperative invasive testing. RESULTS: There were 225 men with complete data. Fiftyseven men (23%) had diabetes and 73 (29%) used indwelling or intermittent catheter prior to surgery. TURP or plasma vaporizaton was performed in 187 (74%) patients and 145 (58%) underwent preoperative invasive testing (cystoscopy or urodynamics). Patients receiving preoperative invasive testing were more likely to have >3 clinic visits within 30 days (OR 3.7, p¼0.005); analyses entering cystoscopy and urodynamics as individual variables shows this attributable to cystoscopy (OR 3.1, p¼0.004). There were no other differences in outcomes among those receiving value-based care. Men with neurologic disease and those undergoing laser vaporization were more likely to fill a BPH medication prescription after surgery (OR 2.8, p¼0.009 and OR 2.5,