Abstract: PD32-01
Sources of Funding: This work was supported by the American Cancer Society (RSG_x000D_ 12-323-01-CPHPS), the National Cancer Institute (R01 CA168691, R01_x000D_ CA174768, T32 CA180984) and the National Institute on Aging (R01_x000D_ AG048071).

Introduction

The USPSTF recommendations against PSA screening for prostate cancer have reduced screening and result in fewer diagnoses. Accountable Care Organizations (ACOs), which aim to improve population health and enhance financial stewardship, have the potential to accelerate the impact of such national recommendations. The extent to which ACOs translate such evidence into practice inevitably will determine their ability to improve value. In this context, we examined the effect of Medicare Shared Savings Program (MSSP) ACO participation on screening PSA tests and prostate biopsy.

Methods

We performed a retrospective cohort study using a 20% national Medicare sample to evaluate rates of PSA testing and prostate biopsy among men without prostate cancer between 2010 and 2014. Patients were aligned to ACOs based on MSSP alignment criteria. We measured secular trends over time and performed a difference-in-differences analysis to determine the causal effects of ACOs on rates of PSA testing and prostate biopsy by comparing outcomes in the post-implementation period to the pre-implementation period.

Results

Among 1.1 million eligible men without prostate cancer, 144,109 (13.7%) were aligned to an ACO. In the non-ACO group we noted a 14% decrease in the annual rate of PSA testing and a 10% decrease in the annual rate of prostate biopsy (both p < 0.001). As shown in the Figure, ACOs had no effect beyond the secular trend on the rate of PSA testing (difference-in-differences estimator p=0.11). However, ACOs accounted a slower decline in the rate of biopsies performed (difference-in-differences estimator p=0.043).

Conclusions

Screening PSA testing and prostate biopsy rates decreased significantly over our study period. The rate of PSA testing, the decision for which is largely under the control of primary care physicians, was not affected by ACO participation. Conversely, the rate of prostate biopsy, the decision for which is under the control of urologists, resulted in a slower decrease in biopsy performance among ACO aligned men. Better engagement of ACOs with specialists is necessary for these organizations to achieve their objective.

Funding

This work was supported by the American Cancer Society (RSG_x000D_ 12-323-01-CPHPS), the National Cancer Institute (R01 CA168691, R01_x000D_ CA174768, T32 CA180984) and the National Institute on Aging (R01_x000D_ AG048071).