SUO 2016: Accountable Care Organizations, Urologist Practice Affiliation and Prostate Cancer - Poster Session Highlights

San Antonio, Texas USA ( Accountable Care Organizations (ACO’s) represent the potential future structure of medical care in the United States. Most ACO’s are developed with primary care specialties at the center, but the incorporation of specialty care is managed variably based on the existence of small single specialty, large single specialty, or multispecialty group practices that the ACO covers.

Prostate cancer is a common disease process that will certainly be managed by ACOs, and the authors from the University of Michigan sought to assess how ACO structure and implementation affected treatment and costs with prostate cancer. They used Medicare data between 2012-2013 to identify Urologist practice context within ACOs using Healthcare Relational Spheres and Beneficiary-level alignment datasets. Multivariable models were used to assess the relationship of ACO penetration with treatment and spending on patients treated by Urologists in single specialty groups.

The findings are intriguing. 7% of patients treated during this time were part of an ACO Shared Savings Program. There was no statistical difference in the rates of curative treatment given to those within an ACO and those not in an ACO (71.4% vs. 70.0%, respectively; p=0.33). This also did not vary by practice context (small vs. large single specialty, or multispecialty group). Perhaps the more surprising finding was that spending was actually higher in the ACO patient population (~$20K vs. $19.7K for non-ACO patients). This, too, did not vary by practice context. However, the higher the number of patients aligned with an ACO within a group, the higher the spending (p <0.05). Non-multispecialty groups appeared to do worse to contain costs than those groups that share accountability among multiple specialties.

The authors therefore concluded that prostate cancer patients aligned with ACOs had similar treatment rates but higher treatment costs, especially in the context of single-specialty groups. This is a crucial point. The development of the ACO model was primarily intended to model a healthcare home for patients around their primary-care needs. The model for incorporating surgical specialties has not been well-defined. Bringing in specialists may help to ramp down costs. For better or for worse, treatment rates have not changed in the 2 years following ACOs, so at least we know patients are likely getting appropriate care.

Authors: Amy Luckenbaugh, Samuel Kaufman, Phyllis Yan, Tudor Borza, Lindsey Herrel, David Miller, Vahakn Shahinian, and Brent Hollenbeck
University of Michigan

Written By: Shreyas Joshi, M.D., Fox Chase Cancer Center

17th Annual Meeting of the Society of Urologic Oncology - November 30 -December 2, 2016 – San Antonio, Texas USA