Mp76-03 marked variation in prostate cancer care among accountable care organizations

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost & Outcomes Measures I1 Apr 2018MP76-03 MARKED VARIATION IN PROSTATE CANCER CARE AMONG ACCOUNTABLE CARE ORGANIZATIONS Parth Modi, Samuel Kaufman, Tudor Borza, Lindsey Herrel, John M. Hollingsworth, Ted Skolarus, David Miller, Vahakn Shahinian, and Brent Hollenbeck Parth ModiParth Modi More articles by this author , Samuel KaufmanSamuel Kaufman More articles by this author , Tudor BorzaTudor Borza More articles by this author , Lindsey HerrelLindsey Herrel More articles by this author , John M. HollingsworthJohn M. Hollingsworth More articles by this author , Ted SkolarusTed Skolarus More articles by this author , David MillerDavid Miller More articles by this author , Vahakn ShahinianVahakn Shahinian More articles by this author , and Brent HollenbeckBrent Hollenbeck More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2571AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Accountable care organizations (ACOs) aim to improve outcomes and reduce costs of healthcare by improving care coordination and avoiding low-value care. Prostate cancer care, with its potential for overtreatment, represents an area for improvement. However, ACOs are focused on primary care providers; specialists may not respond to ACO incentives. In this context, we examined the impact of Medicare Shared Savings Program (MSSP) ACOs on the use of curative treatment and spending for men with prostate cancer. METHODS We used a 20% national sample of Medicare data to identify men diagnosed with prostate cancer from 2012-2014. We assigned each diagnosed man to a primary care physician using MSSP methodology. Primary care physicians were assigned to ACOs using the provider-level Research Identifiable File. We modeled each ACOs propensity to treatment, potentially overtreat (i.e. treat men with ≥75% chance of 10-year mortality) and average Medicare payments in 1 year after diagnosis using logistic and negative binomial regression models. We also characterized ACOs by the proportion of patients who were treated by an ACO-participating urologist. RESULTS We identified 2822 beneficiaries who were assigned to one of 296 ACOs. The median rate of curative treatment among all ACOs was 71.3% (IQR 67%-74.2%). ACO rates of curative treatment ranged from 23.6% to 79.5% (Figure). Among beneficiaries with ≥75% chance of 10-year non-cancer mortality, the median curative treatment rate was 53.6% (IQR 34%-63.4%). Average Medicare payments among ACOs were $21,152.35 (SD $2,589.40). ACOs with more men treated by ACO-participating urologists were less likely to treat men with limited life expectancy than those with fewer men treated by ACO-participating urologists (p=0.03). CONCLUSIONS Considerable variation exists in the use of curative treatment for PCa among ACOs, especially for men with limited life expectancy. ACOs that include more men treated by urologists who are members of an ACO have lower rates of overtreatment, suggesting that ACOs that better engage urologists may have more of an impact on reducing low-value care. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1018-e1019 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Parth Modi More articles by this author Samuel Kaufman More articles by this author Tudor Borza More articles by this author Lindsey Herrel More articles by this author John M. Hollingsworth More articles by this author Ted Skolarus More articles by this author David Miller More articles by this author Vahakn Shahinian More articles by this author Brent Hollenbeck More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...