Abstract: PD32-02
Sources of Funding: This project was supported by the National Cancer Institute (5-T32-CA-180984-03 to Deborah R. Kaye and 1-R01-CA-174768-01-A1 to David C. Miller)

Introduction

Accountable care organizations (ACOs) are a new delivery model that many believe will enhance care coordination and quality, while lowering costs, in patients with complex diagnoses like cancer. However, understanding the degree to which ACO participation improves outcomes depends on the performance of participants before they became ACOs. In this context, we measured and compared the total first year costs (i.e, initial phase) of urological cancer care among hospitals that did or did not enroll in the Medicare Shared Savings Program (MSSP) ACO.

Methods

Using linked SEER-Medicare claims, we identified patients >65 years who were diagnosed with prostate, bladder, or kidney cancer from 2008 through 2012. The initial phase of cancer care was defined by the 12 months after diagnosis for patients living > 12 months. Costs of cancer care were calculated by aggregating hospital, physician and post-acute care claims. We first attributed patients to the hospital at which they received the majority of their initial cancer care. Hospitals were then flagged as ACO or non-ACO hospitals (based on current hospital participation) using the MSSP ACO Provider File. Finally, we compared total and component costs during the initial phase of cancer care according to ACO participation status.

Results

We identified 64,879 patients with prostate cancer, 19,554 patients with bladder and 9,484 patients with kidney cancer. The proportion of patients receiving care at a hospital that subsequently enrolled in the ACO program was 4%, 5%, and 5% for prostate, bladder, and kidney cancer, respectively. Prior to the initiation of the ACO program, patients attributed to current ACO hospitals had lower aggregate first year costs for prostate (p<0.001) and kidney cancer (p<0.001), but not bladder cancer (p=0.938). Differences in inpatient spending were +$305, +$1,245, and -$1,535 for prostate, bladder and kidney cancer, respectively (Figure).

Conclusions

Prior to formal participation, patients treated at hospitals now enrolled in the MSSP ACO program had lower costs for the first 12 months after diagnosis for prostate and kidney cancer, but not bladder cancer. Evaluations of the impact of ACO participation on costs of urologic cancer care may therefore be most fruitful among patients with bladder cancer.

Funding

This project was supported by the National Cancer Institute (5-T32-CA-180984-03 to Deborah R. Kaye and 1-R01-CA-174768-01-A1 to David C. Miller)