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You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost & Outcomes Measures I1 Apr 2018

MP76-10 TRENDS IN AMBULATORY UROLOGICAL SURGERY: AN ANALYSIS OF FIVE STATES IN THE HEALTHCARE COST AND UTILIZATION PROJECT

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    INTRODUCTION AND OBJECTIVES

    Growing concern with the rising costs of healthcare has led to migration of surgical procedures from the inpatient to outpatient setting with 60% or greater of urological procedures performed in the ambulatory setting. Ambulatory surgical centers (ASCs) can potentially reduce costs but may also lead to overutilization. We assessed utilization of ASCs for urological procedures, case-mix distribution compared to hospital-based outpatient surgery, and cost implications using all-payer data from 5 states in the United States.

    METHODS

    The HCUP State Ambulatory Surgery and Services Databases (SASD) from FL, KY, NC, NY, & NV (2010-2014) identified all outpatient urological procedures. Patient demographics, regional data, facility type (ASC vs. hospital-based), surgeon identification (FL & NV), and total charges (converted to costs and inflation adjusted to 2014 $US) were determined. Analyses of the overall number of procedures, rates per 100,000 mid-year state population, annual percent change (APC), proportion performed in ASCs, and adjusted linear regression models were performed.

    RESULTS

    Of >37 million surgical procedures captured, 1,842,630 (4.9%) were urological. Overall APC was +0.97% for all procedures (+1.09% for hospital-based procedures vs. +0.41% for ASCs) with 20.0% performed in ASCs. There was a slight decrease in the adjusted change in proportion performed in ASCs over time (-0.48%/year, p<0.001). Overall costs of urologic cases totaled $19.9 billion representing 7.6% of all ambulatory surgery (average cost/procedure $2,603.76). All procedures demonstrated reduced costs/case when performed in ASCs (range -$800 to -$1800). Unadjusted net cost increase/procedure/year was +$147.79 (+$113.98 after adjustment). The effect was similar across states except NC (-$16.75/procedure/year cost reduction). Providers performing the top quartile (Q1) of procedures demonstrated reduced costs compared to surgeons in other quartiles for Florida (-$50 vs. Q2, -$507 vs. Q3, -$664 vs. Q4) and Q4 for Nevada (-$480 vs. Q4).

    CONCLUSIONS

    Ambulatory urological surgery represents 5% of all cases and 7.6% of costs. The rate of procedures in recent years is increasing steadily with 20% performed in ASCs; the change in market share for ASCs varied by procedure but, overall, was outpaced by hospital-based ambulatory surgery. Procedures amenable to performance in an ASC or by higher volume surgeons were less costly.The cost of ambulatory urological surgery is rising out of proportion to explanation by inflation, patient factors, or case-mix.

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