ACO Engagement With Urologists Can Reduce Overtreatment of Prostate Cancer

Accountable care organizations (ACOs) in the Medicare Shared Savings Program vary considerably in how they treat men with newly diagnosed prostate cancer, according to a study that assessed whether the level of engagement in ACOs by urologists could affect rates of treatment, overtreatment, and spending in prostate cancer care.

The research, published in Cancer, studied Medicare claims of men diagnosed with prostate cancer between 2012 and 2014 and followed the men through the end of 2015. The men were 66 years and older and had continuous enrollment in Medicare parts A and B for 1 year before and after a new diagnosis.

“Policies that align financial incentives with evidenced-based management (ie, those that improve value) have the potential to affect the treatment of prostate cancer,” the authors noted. “[ACOs] are emblematic of such a policy.”

However, ACOs are organized around the primary care physician, and a minority of surgeons and urologists, who may be able to influence care delivery in clinical areas such as prostate cancer, participate in ACOs.

Of the 2822 men with newly diagnosed prostate cancer assigned to an ACO, the median treatment rate was 71.3% (range, 23.6% to 79.5%). In addition, 255 men were subject to potential overtreatment, because they had a 75% or greater chance of dying within 10 years from a reason other than cancer. While there were no significant associations between race, comorbidity, or socioeconomic status and potential overtreatment, the researchers did find that younger age was associated with potential overtreatment.

The ACOs ran the gamut of urologist engagement from ACOs that had no patients with prostate cancer being managed by an ACO-participating urologist to 100% of patients with prostate cancer being treated by an ACO-participating urologist. Overall, ACO—urologist engagement was associated with reduced use of potential overtreatment for men who had a high risk of a noncancer mortality. However, urologist engagement was not significantly associated with overall treatment rate or spending in the first year after diagnosis.

“The ability of an ACO to engage urologists is associated with how often it provides prostate cancer treatment to men who are unlikely to benefit,” the authors concluded. “Further research is needed to understand how ACOs can better engage urologists, whether by improved care coordination, directed referral patterns, or modification of financial incentives.”

Reference

Modi PK, Kaufman SR, Borza T, et al. Variation in prostate cancer treatment and spending among Medicare Shared Savings Program accountable care organizations. Cancer. 2018;124(16):3364-3371. doi: 10.1002/cncr.31573.