MP76-05 COSTS OF UROLOGIC CANCER CARE ACROSS THE DISEASE CONTINUUM

Le résumé fourni par la source

INTRODUCTION AND OBJECTIVES: Accountable care organizations (ACOs) aim to improve outcomes and reduce costs of healthcare by improving care coordination and avoiding low-value care.Prostate cancer care, with its potential for overtreatment, represents an area for improvement.However, ACOs are focused on primary care providers; specialists may not respond to ACO incentives.In this context, we examined the impact of Medicare Shared Savings Program (MSSP) ACOs on the use of curative treatment and spending for men with prostate cancer.METHODS: We used a 20% national sample of Medicare data to identify men diagnosed with prostate cancer from 2012-2014.We assigned each diagnosed man to a primary care physician using MSSP methodology.Primary care physicians were assigned to ACOs using the provider-level Research Identifiable File.We modeled each ACOs propensity to treatment, potentially overtreat (i.e.treat men with 75% chance of 10-year mortality) and average Medicare payments in 1 year after diagnosis using logistic and negative binomial regression models.We also characterized ACOs by the proportion of patients who were treated by an ACO-participating urologist.RESULTS: We identified 2822 beneficiaries who were assigned to one of 296 ACOs.The median rate of curative treatment among all ACOs was 71.3% (IQR 67%-74.2%).ACO rates of curative treatment ranged from 23.6% to 79.5% (Figure ).Among beneficiaries with 75% chance of 10-year non-cancer mortality, the median curative treatment rate was 53.6% (IQR 34%-63.4%).Average Medicare payments among ACOs were $21,152.35(SD $2,589.40).ACOs with more men treated by ACO-participating urologists were less likely to treat men with limited life expectancy than those with fewer men treated by ACO-participating urologists (p¼0.03).CONCLUSIONS: Considerable variation exists in the use of curative treatment for PCa among ACOs, especially for men with limited life expectancy.ACOs that include more men treated by urologists who are members of an ACO have lower rates of overtreatment, suggesting that ACOs that better engage urologists may have more of an impact on reducing low-value care.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.