Physician Payment Incentives and Active Surveillance in Low-Risk Prostate Cancer.

Importance: Active surveillance in men with less aggressive prostate cancer is inconsistently used despite clinical guidelines. Renumeration generally favors treatment over conservative management and may contribute to the variable adoption of active surveillance, which suggests that value-based payment incentives may promote guideline-concordant care.

Objective: To describe the adoption of active surveillance in low-risk prostate cancer, following the initiation of a novel payment incentive sponsored by a commercial payer to support its use.

Commercial Prices and Care for Medicare Beneficiaries With Prostate Cancer.

Objective: To examine the relationship between market dynamics, in the form of commercial prices paid to urologists, and utilization of services, as measured by Medicare spending, in men with newly diagnosed prostate cancer.

Methods: We performed a retrospective national cohort study of Medicare beneficiaries with newly diagnosed prostate cancer between 2014 and 2019, with follow-up through 2020. The primary exposure was the commercial price index (ie, the ratio of commercial prices to Medicare prices for a common set of services performed by urologists).

Commercial prices and their influence on urology practices: Prostate cancer care among men with Medicare.

Background: For men with prostate cancer, there is substantial variation in the use of conservative management, such as active surveillance. Commercial prices, which vary across urology practices, may afford incentives that foster physician behaviors associated with utilization. Such behaviors may "spillover" to the Medicare population and affect quality.

Implementation of a Standardized Process of Coude Catheter Insertion Decreases Traumatic Catheterizations.

Objective: To address the issue of traumatic foley catheterization, we developed and implemented a coude catheter education program for operating room nurses as well as standardize the usage of a coude catheter for male patients. Traumatic catheterization leads to patient morbidity and increased healthcare costs.

Methods: A retrospective review was conducted to identify all traumatic catherizations over a 6-month period for several surgical services at our institution.

Association of Community-Level Social Vulnerability With Clinical Trial Discussion and Participation Among Cancer Survivors.

Purpose: Community factors and structural barriers may contribute to disparities and underrepresentation in cancer clinical trials. We evaluate the influence of community-level social determinants of health, as measured by the Centers for Disease Control and Prevention Social Vulnerability Index (SVI), on disparities in cancer clinical trial discussion and participation.

Methods: We performed a cross-sectional analysis of the 2021 Health Information National Trends Survey-SEER, a representative survey of cancer survivors sampled from three SEER registries.

Social Vulnerability and Receipt of Neoadjuvant Chemotherapy in Patients Undergoing Radical Cystectomy for Bladder Cancer.

Objective: To evaluate the association between a population-level measure of social determinants of health, the Centers for Disease Control and Prevention Social Vulnerability Index (SVI), and receipt of neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy.

Methods: We queried our institutional database for patients with nonmetastatic MIBC treated with radical cystectomy between 2000 and 2022. Patients were assigned an SVI via ZIP code of residence and grouped into quintiles of SVI (ie, least vulnerable to most vulnerable).

The 340B Program and oral specialty drugs for advanced prostate cancer.

Introduction: Expensive oral specialty drugs for advanced prostate cancer can be associated with treatment disparities. The 340B program allows hospitals to purchase medications at discounts, generating savings that can improve care of the socioeconomically disadvantaged. This study assessed the effect of hospital 340B participation on advanced prostate cancer.

Value-based payment models and management of newly diagnosed prostate cancer.

Objective: To examine the effect of urologist participation in value-based payment models on the initial management of men with newly diagnosed prostate cancer.

Methods: Medicare beneficiaries with prostate cancer diagnosed between 2017 and 2019, with 1 year of follow-up, were assigned to their primary urologist, each of whom was then aligned to a value-based payment model (the merit-based incentive payment system [MIPS], accountable care organization [ACO] without financial risk, and ACO with risk). Multivariable mixed-effects logistic regression was used to measure the association between payment model participation and treatment of prostate cancer.

Urologist practice divestment from radiation vault ownership and treatment patterns for prostate cancer.

Background: Urologists practicing in single-specialty groups with ownership in radiation vaults are more likely to treat men with prostate cancer. The effect of divestment of vault ownership on treatment patterns is unclear.

Methods: A 20% sample of national Medicare claims was used to perform a retrospective cohort study of men with prostate cancer diagnosed between 2010 and 2019.

The immediate effects of private equity acquisition of urology practices on the management of newly diagnosed prostate cancer.

Introduction: Some worry that physician practices acquired by private equity may increase the use of services to maximize revenue. We assessed the effects of private equity acquisition on spending, use of treatment, and diagnostic testing in men with prostate cancer.

Methods: We used a 20% sample of national Medicare claims to perform a retrospective cohort study of men with prostate cancer diagnosed from 2014 through 2019.

Acquisition of Urology Practices by Private Equity Firms and Performance in the Merit-based Incentive Payment System.

Introduction: Private equity is increasingly engaged in the acquisition of urology practices. The implications of strategies to enhance practice value deployed by these firms for patients are unclear.

Methods: We conducted a retrospective study of urologist performance in the MIPS (Merit-based Incentive Payment System) program for 2017 to 2020 using national Medicare data from the Quality Payment Program file.

Association Between Urologist Merit-Based Incentive Payment System Performance and Quality of Prostate Cancer Care.

Introduction: We performed a study to evaluate the association between urologist performance in the Merit-Based Incentive Payment System (MIPS), and quality and spending for prostate cancer care.

Methods: Medicare beneficiaries with prostate cancer diagnosed between 2017 and 2019 were assigned to their primary urologist. Associated MIPS scores were identified and categorized based on thresholds for payment adjustment as low (worst), moderate, and high (best).

Association between urology practice use of multiparametric MRI and genomic testing and treatment of men with newly diagnosed prostate cancer.

Introduction: Biomarkers for prostate cancer, such as multiparametric MRI (mpMRI) and tissue-based genomics, are increasingly used for treatment decision-making. Using biomarkers indiscriminately and thus ignoring competing risks of mortality may lead to treatment in some men who derive little clinical benefit. We assessed the relationship between urology practice use of biomarkers and subsequent treatment in men with newly diagnosed prostate cancer.

Accountable care organizations and use of surgery among patients with Alzheimer disease and related dementias.

Objective: To understand the effects of accountable care organizations (ACOs) on use of surgery in patients with Alzheimer disease and related dementias (ADRD).

Study Design: Retrospective national cohort study of all Medicare beneficiaries identified in a 20% sample between 2010 and 2017. The primary exposure was participation in ACOs.

Health care delivery system contributions to management of newly diagnosed prostate cancer.

Background: Despite clinical guidelines advocating for use of conservative management in specific clinical scenarios for men with prostate cancer, there continues to be tremendous variation in its uptake. This variation may be amplified among men with competing health risks, for whom treatment decisions are not straightforward. The degree to which characteristics of the health care delivery system explain this variation remains unclear.

National Trends in Management of Newly Diagnosed Prostate Cancer.

Background: Deciding whether to treat or conservatively manage patients with prostate cancer is challenging. Recent changes in guidelines, advances in treatment technologies, and policy can influence decision making surrounding management, particularly for those for whom the decision to treat is discretionary. Contemporary trends in management of newly diagnosed prostate cancer are unclear.

Barriers to rural health care from the provider perspective.

Introduction: Rural populations routinely rank poorly on common health indicators. While it is understood that rural residents face barriers to health care, the exact nature of these barriers remains unclear. To further define these barriers, a qualitative study of primary care physicians practicing in rural communities was performed.

New technology in prostate cancer and financial toxicity.

The management of prostate cancer has significantly evolved over the last few decades with the emergence of new diagnostic and treatment technologies, which are typically more expensive than the previous alternatives. However, decision-making regarding which diagnostics and treatment to pursue is often influenced by perceived benefits, adverse effects, and physician recommendations, without considering the financial liability borne by patients. New technologies may exacerbate financial toxicity by replacing less costly alternatives, promoting unrealistic expectations, and expanding treatment to those who would have previously gone untreated.

Practice Competition and Treatment of Newly Diagnosed Prostate Cancer.

Objective: To examine the effect of urology practice market competition on use of treatment in men with newly diagnosed prostate cancer.

Methods: We performed a retrospective national cohort study of 48,067 Medicare beneficiaries with newly diagnosed prostate cancer between 2014 and 2018. The primary exposure was urology practice-level market competition.

Merit-based Incentive Payment System Quality Reporting in Urology Practices.

Introduction: Most urologists are required to participate in Merit-based Incentive Payment System-an alternative payment model in which physicians must track and report quality measures. However, Merit-based Incentive Payment System measures are urology-specific, and it remains unclear what measures urologists are choosing to track and report.

Methods: We performed a cross-sectional analysis of Merit-based Incentive Payment System measures reported by urologists for the most recent performance year.

Effects of In-office Dispensing by Single-specialty Urology Practices on Management of Advanced Prostate Cancer.

Introduction: We examine changes in the volume of patients with advanced prostate cancer and prescriptions for abiraterone and enzalutamide among urology practices with and without in-office dispensing.

Methods: Using data from the National Council for Prescription Drug Programs, we identified in-office dispensing by single-specialty urology practices from 2011 to 2018. As the greatest growth in implementing dispensing occurred among large groups in 2015, outcomes were measured at the practice level in 2014 (before) and 2016 (after) for dispensing and non-dispensing practices.

Re: Implementation and Assessment of No Opioid Prescription Strategy at Discharge After Major Urologic Cancer Surgery.

The authors prospectively evaluated the implementation of a prespecified protocol to eliminate post-discharge opioid prescription after major urologic cancer surgery at a single center among a predominantly opioid naïve population. The intervention included both provider and patient education along with a standardized regimen for non-opioid analgesia during the inpatient stay and after discharge. Use of a standardized protocol nearly eliminated opioid prescriptions after major urologic cancer surgery without adversely impacting patient reported pain control and satisfaction, unplanned visits, and complications.