Research Activities, November-December 2013
Urological surgery rare, more expensive at rural critical access hospitals
Health Care Costs and Financing
Critical access hospitals (CAHs)—small, rural hospitals with a maximum of 25 acute care beds—are significantly less likely to perform inpatient urological surgery than are other acute care hospitals, according to a new study. The designation of a hospital as "critical access" allows it to receive cost-plus reimbursement from Medicare as well as more flexibility in physician and nurse staffing.
In rural areas, most acute care is performed at CAHs. The researchers compared data on urologic surgery admissions at CAHs and non-CAHs from the AHRQ Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP–NIS). They found a total of 333,925 urological surgery admissions for both types of hospitals for the period 2005 through 2009, including 2,286 (0.7 percent) admissions at CAHs. Fewer than half of CAHs (45 percent) had at least 1 inpatient urological operation performed compared with 91 percent of non-CAHs.
CAHs had a greater prevalence of operations for benign indications (such as benign prostatectomy), while major cancer operations constituted a smaller proportion of CAH than non-CAH urologic surgeries (16 percent vs. 33 percent). There were no meaningful differences in in-hospital deaths and length of hospital stays between patients treated at CAHs and non-CAHs for six common inpatient urological surgeries. However, the costs at CAHs were universally higher.
The findings were based on analysis of data from the American Hospital Association and the AHRQ HCUP–NIS. The study was funded in part by AHRQ (HS18346).
More details are in "Inpatient urological surgery at critical access hospitals in the United States," by Adam J. Gadzinski, M.D., M.S., Justin B. Dimick, M.D., M.P.H., ZaoJin Ye, M.S., and others in the April 2013 The Journal of Urology 189(3), pp. 1475-1480.