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Association between hospital participation in Medicare Shared Savings Program and hospital use of robotic surgical
Katia Noyes1,2, Brooks Harmon3, Joseph D Boccardo4
1Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 270 Farber Hall, Buffalo, NY, 14214, USA. enoyes@buffalo.edu.
Background:
In 2012, Medicare introduced Shared Savings Program (MSSP) accountable care organizations (ACO) model to improve the value of health care services as a part of the national comprehensive Accountable Care Act. While the effect of the MSSP on primary care has been extensively analyzed, little is known about the effect of the MSSP on cost and quality of surgical care, in particular the use of high-cost robotic surgical modalities. Hospitals routinely market robotic procedures as an indicator of high quality, despite limited evidence of their clinical value. This study examines the relationship between hospital participation in the MSSP and use of robotic surgery.
Methods:
We conducted a retrospective analysis using 2016-2019 publicly available data on hospital MSSP participation and use of robotic-assisted procedures in New York State. Using bivariate and multivariate approaches, we identified hospital characteristics associated with the use of robotic technique and hospital quality.
Results:
Of the 157 general hospitals in NYS, 83 (53%) offered robotic surgery and 73 (47%) participated in the MSSP. MSSP-affiliated hospitals were more selective in the type of robotic procedures than non-MSSP hospitals, favoring procedures with stronger evidence-base such as prostatectomies. Hospitals that performed robotic surgery selectively had significantly lower spending per patient (p = 0.04). Higher volume of robotic procedures correlated with higher hospital ranking.
Conclusions:
MSSP participation is associated with more selective use of robotic procedures and lower hospital spending. More research is needed to understand the relationship between hospital investments in quality improvement, use of robotic surgery and hospital performance rankings.
