According to a recent study that was first published in the journal Cancer last June, accountable care organizations (ACOs) have an impact on prostate cancer treatment cost and results. In fact, the study found that ACOs in the Medicare Shared Savings Program vary considerably in how these programs treat men with newly diagnosed prostate cancer. Another point of interest was as to whether the level of engagement in ACOs by urologists could affect rates of treatment, overtreatment, and healthcare cost on prostate cancer care.
The research looked at the Medicare claims of men who had been diagnosed with prostate cancer between the years of 2012 and 2014. These men’s treatments were followed and documented until the end of 2015. The research group was made up of males who were 66 years in age or older. All of the men had continuous enrollment in Medicare parts A and B for 1 year before and after a new diagnosis.
Out of the 2822 men in the study with newly diagnosed prostate cancer assigned to an ACO, the median treatment rate was 71.3 percent. In addition, 255 men were subject to potential overtreatment, because they had a 75 percent or greater chance of dying within 10 years from a reason other than cancer. There were no significant associations between race, comorbidity, socioeconomic status and potential overtreatment. However, researchers did discover that the younger a patient’s age correlated to a greater potential for overtreatment.
Urologist’s engagement ranged from ACOs that had no patients with prostate cancer to other ACOs with participating urologist to treating 100% of patients with prostate cancer. Overall, ACO and 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 research suggests that accountable care organizations (ACOs) can improve the quality of care delivered, while reducing expenditures. Data suggest that strongly engaged urologist were less likely to promote overtreatment for prostate cancer. This is when compared to ACOs without such engagement by treating men with a high risk of noncancer mortality. Policies that align financial incentives with evidenced-based management (value added) have the potential to affect prostate cancer treatments. This improves the overall value of specialty care.
The modeled median of provided treatment among all ACOs was 71·3% and median overtreatment was 53·6%. The engagement of urologists with ACOs did not affect the use of treatment or Medicare expenditure, but in the subset of patients who had a high risk of 10-year mortality, stronger engagement of urologists with ACOs was associated with lower risk of overtreatment.
Many healthcare providers would agree that overtreament is a harmful, wasteful and common occurrence. Out of a survey of 2,106 physicians in various medical specialties regarding their beliefs about unnecessary medical care, the doctors believed that 20.6 percent of all medical care was unnecessary. One of the main elements driving overtreatment was the fear of malpractice lawsuits.
However, only 2 to 3 percent of patients actually pursue litigation. The vast majority of healthcare practitioners stated that patients demand unnecessary treatments. Other reasons for overtreatment include limited access to medical records, profit and financial security.
The study’s conclusion is that ACOs can vary widely in treatment, potential overtreatment, and spending on prostate cancer. However, the ACOs with stronger engagement from urologist were are less likely to treat men with a high risk of noncancer mortality. This finding suggests that healthcare organizations that are better able to engage specialists may be able to improve the value of specialty care delivered to patients.
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Urologists, ACOs, Overtreatment, Prostate Cancer