SUO 2017: Prostate Cancer Treatment Variation in Accountable Care Organizations

Washington, DC ( Dr. Parth Modi presented on prostate cancer treatment variation in Accountable Care Organizations (ACOs). 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 important area for potential improvement. However, ACOs are focused on primary care providers, and as such specialists may not benefit from ACO incentives. The objective of this study was to examine the impact of Medicare Shared Savings Program (MSSP) ACOs on the use of curative treatment and treatment cost for prostate cancer.           

For this study, primary care physicians were assigned to ACOs using the provider-level Research Identifiable File. Patients diagnosed with prostate cancer in 2012-2013 were then assigned to primary care physicians using MSSP methodology to establish beneficiary ACO alignment. Rates of treatment, potential overtreatment (for example, treatment in men with > 75% chance of 10-year mortality) and Medicare payments were measured at the ACO-level using logistic and negative binomial regression models. ACOs were characterized by the proportion of patients who were treated by an ACO-aligned urologist. There were 1437 beneficiaries identified and assigned to one of 199 ACOs. The mean rate of curative treatment among all ACOs was 69.5% (IQR 65.4-74.8%), ranging from 23.3% to 83.1%. When considering beneficiaries with >75% chance of 10-year non-cancer mortality, the mean curative treatment rate was 43.0% (IQR 28.0%-61.1%). Average Medicare payments among ACOs was $21,604.33 (IQR $12,534.61-$22,748.62). Interestingly, ACOs with the smallest proportion of men treated by ACO-aligned urologists had significantly higher rates of potential overtreatment than ACOs with the largest proportion (24.6% v 57.6%, p=0.036).

Dr. Modi concluded noting that considerable variation exists in the use of curative treatment for prostate cancer 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.

Presented by: Parth Modi, Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
Co-Authors: Samuel Kaufman, Tudor Borza, Phyllis Yan, Vahakn Shahinian, Brent Hollenbeck

Written By: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC