Pd08-05 the Impact of Hospital Consolidation and for-Profit Status on Prostate Cancer Costs and Quality of Care

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes I (PD08)1 May 2024PD08-05 THE IMPACT OF HOSPITAL CONSOLIDATION AND FOR-PROFIT STATUS ON PROSTATE CANCER COSTS AND QUALITY OF CARE Katharine F. Michel, Michelle Slinger, S. Bruce Malkowicz, Thomas J. Guzzo, Sumedha Chhatre, and Ravishankar Jayadevappa Katharine F. MichelKatharine F. Michel , Michelle SlingerMichelle Slinger , S. Bruce MalkowiczS. Bruce Malkowicz , Thomas J. GuzzoThomas J. Guzzo , Sumedha ChhatreSumedha Chhatre , and Ravishankar JayadevappaRavishankar Jayadevappa View All Author Informationhttps://doi.org/10.1097/01.JU.0001008576.33217.96.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Healthcare in the US continues to be plagued by rising costs. Concomitantly, the US market has experienced consolidation of hospitals, which some theorize may be contributing to rising costs. Others, however, postulate that increased consolidation may lead to cost savings, and regardless may be justified by improved clinical care. In this study we examine the associations between hospital competition, for-profit status, cost, and quality of care within the Medicare prostate cancer population. METHODS: Claims for men aged≥66 diagnosed with localized prostate cancer (diagnosis from 2000-2011, claims from 1999-2019) were collected from the Surveillance, Epidemiology, and End Results (SEER)–Medicare database. Hirschman-Herfindahl index (HHI) was calculated to quantify hospital competition (higher values indicate more concentration and thus less competition). Outcomes were Medicare expenditure, emergency room (ER) visits, and overall mortality. Poisson models were used to predict ER visits, Generalized Linear Models for expenditures, and Cox models for mortality. A propensity score derived from age, race and ethnicity, marital status, cancer grade, census tract poverty indicator, and Charlson co-morbidity score as well as an interaction term between HI and for-profit status were also included. RESULTS: There were 253,176 patients identified in this cohort. For each increasing unit of HHI (ie less competition) there was 9% increase in expenditure (eβ: = 1.09, 95% CI, 1.04–1.17) and 17% increase in ER visit rate (IRR: 1.17, 95% CI: 1.15–1.19). There was no statistically significant association between HHI and mortality.49% of hospitals were non-profit, 24% were for-profit, and 26% government. Although the interaction term between hospital profit-status and HHI was statistically non-significant, the trend indicates that HHI has a larger magnitude impact on non-profit hospitals. Each unit increase in HHI increased the rate of ER visits by 24% for for-profit hospitals and 48% for not-for-profit hospitals. Similarly, hazard of mortality increased by 9% for each unit of HHI for for-profit hospitals and 15% for non-profit hospitals. CONCLUSIONS: Lower hospital competition was associated with higher expenditure and ED visits for Medicare prostate cancer patients. The impact of competition may be greater on non-profit hospitals. This highlights the need to be cautious in supporting hospital consolidation and for further research exploring these relationships with more granularity and for other diseases. Source of Funding: Funding Agency: Department of Defense.Study Title: Factors Associated with Racial and Ethnic Disparity in Quality of Prostate Cancer Care Among Veterans and Non-Veterans.Grant number: W81XWH-19-1-0461Principal Investigator: Ravi Jayadevappa © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e174 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Katharine F. Michel More articles by this author Michelle Slinger More articles by this author S. Bruce Malkowicz More articles by this author Thomas J. Guzzo More articles by this author Sumedha Chhatre More articles by this author Ravishankar Jayadevappa More articles by this author Expand All Advertisement PDF downloadLoading ...