Abstract: PD14-02
Sources of Funding: This project was supported by the National Cancer Institute (T32-CA-180984-03 to Deborah R. Kaye and 1-R01-CA-174768-01-A1 to David C. Miller).

Introduction

In an effort to help patients identify high-quality hospitals, CMS recently released Hospital Compare, a 5-star hospital ranking system. We evaluated the relationship between CMS hospital star rankings and short-term outcomes after major urological cancer surgery.

Methods

Using national Medicare claims and public-use files from the Hospital Compare program, we identified patients aged 66 to 99 who underwent a major prostate, bladder or kidney cancer surgery from January 1, 2011 through November 30, 2013. For each patient, we determined the CMS star rating (i.e., 1-5-star) for the hospital performing the surgery, as well as the occurrence of 30- day complications, mortality, readmissions, and/or prolonged length of stay. Hospital Compare excludes cancer specific quality measures in its methodology. We then performed univariable and multivariable analyses to examine the overall and procedure-specific associations between hospital star ratings and each surgical outcome.

Results

We identified 122,321 patients undergoing prostate, bladder, or kidney cancer surgery at 2,147 hospitals rated in the Hospital Compare file. Five percent of hospitals were graded 1 star, 24% 2 stars, 44% 3 stars, 25% 4 stars and 3% 5 stars. For all three procedures combined, we identified a significant, inverse association between CMS star ranking and the occurrence of each adverse outcome (Figure 1). For instance, adjusted rates of readmission for 1- vs 5-star hospitals, were 11.3% and 8.1%, respectively (p=<0.001); likewise, rates of mortality at 1 and 5 star hospitals were 1.7% and 0.6%, respectively (p=<0.001). We identified similar relationships in separate procedure-specific analyses (Table 1).

Conclusions

Short-term outcomes after major urological cancer surgery are better for Medicare beneficiaries treated at hospitals with higher CMS Hospital Compare star ratings, suggesting a potential role for these rankings in guiding choice of hospitals. Additional research is needed, however, to determine if the star rankings accurately reflect other measures of quality in urological cancer care.

Funding

This project was supported by the National Cancer Institute (T32-CA-180984-03 to Deborah R. Kaye and 1-R01-CA-174768-01-A1 to David C. Miller).