Login to Access Video or Poster Abstract: MP32-20
Sources of Funding: This work was supported by research funding from the NCI (R01 CA168691) to BKH and VBS. FRS is supported by the Department of Veterans Affairs, Veterans Health Administration, VISN1 Career Development Award.

Introduction

Current health care reforms focused on optimizing value, higher quality of care delivered at a lower cost, are particularly relevant for prostate cancer due to its high cost in the context of wide variations in its treatment. We examined the potential impact of urologist practice structure on the value of prostate cancer care.

Methods

Using a 20% sample of national Medicare claims and data from the Surveillance, Epidemiology and End-Results (SEER)-Medicare linked registry, we examined spending (Medicare cohort) and quality (SEER-Medicare cohort) of prostate cancer treatment according to urologist practice type (single-specialty vs. MSG), size and ownership of an intensity modulated radiation therapy (IMRT) vault. Mixed models were used to adjust for patient differences.

Results

We identified 28,164 men with newly diagnosed prostate cancer treated by 6,381 urologists during our study interval (SEER cohort: 22,412 men and 2,199 urologists). We observed excess spending of $2,416 per beneficiary for large group practices compared to MSGs, and $2,770 in excess spending per beneficiary for practices with IMRT ownership compared to non-owning practices (p<0.001, Table). Adherence to all eligible quality measures was modestly better among MSGs compared to single specialty groups (20.0% adherence versus 18.2%, p=0.01) whereas there was no significant difference by ownership of IMRT (17.1% adherence in owners versus 18.9% non-owners, p=0.09).

Conclusions

Practices within MSGs demonstrate the lowest, whereas practices with IMRT ownership demonstrate the highest spending for prostate cancer care. Differences in quality were modest and of uncertain clinical importance, with substantial room for improvement, regardless of practice structure.

Funding

This work was supported by research funding from the NCI (R01 CA168691) to BKH and VBS. FRS is supported by the Department of Veterans Affairs, Veterans Health Administration, VISN1 Career Development Award.