Presentation Authors: David F. Friedlander*, Brighton, MA, Marieke J. Krimphove, Alexander P. Cole, Maya Marchese, Gezzer Ortega, George E. Haleblian, Quoc-Dien Trinh, Boston, MA
Introduction: Medicaid expansion is a key provision by which the Affordable Care Act seeks to improve access to health insurance. However, there is concern over the quality and cost of care received by Medicaid beneficiaries. We previously demonstrated that payer status predicts index care setting, which influences rates of 30-day revisits following definitive surgery for urinary stone disease. In this context, we used all-payer claims data to identify predictors of 30-day revisit and associated cost following definitive surgery for nephroureterolithiasis.
Methods: All-payer data from the 2014 Healthcare Cost and Utilization Project State Databases from Florida and New York were used to identify all index elective definitive surgical interventions for nephroureterolithiasis in the form of ureteroscopy (URS) or shockwave lithotripsy (SWL). Patient demographics, regional data, 30-day revisit rates, and total charges (converted to costs) associated with revisits were determined. Multivariate logistic regression adjusted for facility clustering was utilized to identify predictors of re-intervention following definitive therapy for nephroureterolithiasis.
Results: Of the 27,527 unique patients undergoing either an elective index URS (n=16,572) or SWL (n=10,955), 8.5% experienced a 30-day revisit at a median cost of $4,444.36 per revisit. Inpatient versus ambulatory procedures accounted for 25.4% and 74.6% of 30-day revisits, respectively (P < 0.001). Predictors of experiencing a 30-day revisit included higher comorbidity burden (Charlson Comorbidity Index â‰¥2 vs. 0: OR 1.39, 95% CI 1.20-1.61; P < 0.001), payer status (Medicaid vs. Medicare: OR 1.38, 95% CI 1.11-1.72; P=0.004), lower median household income (â‰¥$66,000 vs. < $40,000: OR 0.79, 95% CI 0.63-0.99; P=0.04), index care setting (ambulatory vs. inpatient: OR 0.83, 95% CI 0.73-0.95; P=0.006), and procedure type (URS vs. SWL: OR 0.74, 95% CI 0.66-0.83; P < 0.001).
Conclusions: We demonstrated that payer status and index care setting are independent predictors of 30-day revisit following elective definitive stone therapy, with Medicaid beneficiaries experiencing higher 30-day revisit rates. Our findings have important policy and cost implications in the setting of recent efforts to expand healthcare coverage through Medicaid expansion.
Source of Funding: Quoc-Dien Trinh is supported by the Brigham Research Institute Fund to Sustain Research Excellence, the Bruce A. Beal and Robert L. Beal Surgical Fellowship, the Genentech Bio-Oncology Career Development Award from the Conquer Cancer Foundation of the Ame