Login to Access Video or Poster Abstract: MP32-05
Sources of Funding: American Cancer Society (MSRG-15-103-01-CHPHS to MJR), AUA/Urology Care Foundation Rising Stars in Urology Research Program

Introduction

While Accountable Care Organizations (ACOs) continue to rapidly proliferate, there remain few empiric data that specifically evaluate the effect of ACO enrollment on the cancer diagnosis, treatment, and survivorship. To this end, we characterize the effect of early Medicare Shared Savings (MSSP) Program enrollment on the prevalence of prostate cancer screening.

Methods

We built a cohort of aged Medicare beneficiaries from 2010 through 2013 comprising 17,779,120 person-years and 9,201,163 person-years before and after ACO enrollment, respectively. We characterized our exposure of interest, MSSP ACO enrollment, by identifying all MSSP-enrolled primary care providers and recapitulating published attribution strategies, and identified our outcome of interest, PSA screening, through relevant Medicare claims. We subsequently performed differences-in-differences analysis specifically evaluating the interaction between ACO enrollment and the period following ACO intervention to characterize the effect of MSSP ACO enrollment on the prevalence of prostate cancer screening.

Results

Medicare beneficiaries attributed to MSSP ACO-enrolled primary care providers were 2.5% more likely to undergo PSA screening than those attributed to non-ACO primary care providers prior to deployment of the MSSP (p<0.0001). We observed significant reductions in the prevalence of PSA screening throughout the study period among both ACO and non-ACO groups. Nonetheless, the rate of decline in the ACO group outpaced that of the non-ACO group, with an observed difference-in-difference of 0.742% (p<0.0001).

Conclusions

ACO enrollment appears to significantly mediate observed reductions in the prevalence of PSA screening among Medicare beneficiaries, although the absolute magnitude of this effect is relatively small. Characterizing the potential additive effects of guideline modifications and payment reforms will be essential to predict the future landscape of prostate cancer epidemiology.

Funding

American Cancer Society (MSRG-15-103-01-CHPHS to MJR), AUA/Urology Care Foundation Rising Stars in Urology Research Program