Utilization and Outcomes of Inpatient Urological Care at Safety Net Hospitals.
OBJECTIVE
Because proposed funding cuts in the Patient Protection and Affordable Care Act may impact care for urological patients at safety net hospitals, we examined the use, outcomes and costs of inpatient urological surgery at safety net vs nonsafety net facilities prior to health care reform.


METHODS
Using the Nationwide Inpatient Sample we performed a retrospective cohort study of patients who underwent inpatient urological surgeries from 2007 through 2011. We defined the safety net burden of each hospital based on the proportion of Medicaid and self-pay discharges. We examined the distribution of urological procedures performed and compared in-hospital mortality, prolonged length of stay and costs in the highest quartile of burden (safety net) vs the lowest quartile (nonsafety net).


RESULTS
The distribution of urological procedures differed by safety net status with less benign prostate surgery (9.1% safety net vs 11.4% nonsafety net) and major cancer surgery (26.9% vs 34.3%), and more reconstructive surgery (8.1% vs 5.5%) at safety net facilities (p <0.001). Higher mortality at safety net hospitals was seen for nephrectomy (OR 1.68, 95% CI 1.15-2.45) and transurethral resection of the prostate (OR 2.17, 95% CI 1.22-3.87). Patients in safety net hospitals demonstrated greater prolonged length of stay after endoscopic stone surgery (OR 1.20, 95% CI 1.01-1.41). Costs were similar across procedures except for radical prostatectomy and cystectomy. For these procedures the average admission was more expensive at nonsafety net facilities (prostatectomy $11,457 vs $9,610 and cystectomy $27,875 vs $24,048, each p <0.02).


CONCLUSIONS
Reductions in funding to safety net hospitals with health care reform could adversely impact access to care for patients with a broad range of urological conditions, potentially exacerbating existing disparities for vulnerable populations served by these facilities.
Department of Urology, Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
Lindsey A
LA
Herrel
Department of Urology, Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
Zaojun
Z
Ye
Department of Urology, Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan. Electronic address: dcmiller@med.umich.edu.
David C
DC
Miller
D005500:Follow-Up Studies; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D058991:Patient Protection and Affordable Care Act / Q000191:economics* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000592:standards*; D014481:United States; D013520:Urologic Surgical Procedures / Q000191:economics* / Q000592:standards
Patient Protection and Affordable Care Act; healthcare disparities; hospitals; outcome assessment (health care); urologic surgical procedures