Presentation Authors: Alexander Putnam Cole*, Anna Krasnova, Ashwin Ramaswamy, David Fallon Friedlander, Sean Anthony Fletcher, Maxine Sun, Toni K. Choueiri, Joel S. Weissmann, Stuart R. Lipsitz, Adam S. Kibel, Quoc-Dien Trinh, Boston, MA
Introduction: Accountable care organizations are a delivery and payment model designed to improve coordination of care and reduce low value care. A study was designed to assess whether total Medicare expenditures for men with prostate cancer treated in Accountable Care Organizations (ACOs) differ from those of men treated in non-ACOs.
Methods: Using the 20% Medicare sample, men with incident prostate cancer were identified. The ACO cohort consisted of men with providers in the Medicare Shared Savings Program - which is currently the largest ACO program in the United States. Prostate cancer expenditures were calculated by subtracting total charges from the year prior to diagnosis. Propensity score weighting was used to balance baseline characteristics of men treated in ACOs and non-ACOs, and between treatment modalities (radiation, prostatectomy and observation/surveillance). A propensity score weighted regression model was then used to estimate mean expenditures for men treated in ACOs and non-ACOs and to test the association between ACO status and prostate cancer expenditures.
Results: In total, 3,297 men were treated in ACOs for localized prostate cancer, versus 24,088 in the non-ACO cohort. The weighted total charges for each treatment modality were $32,358 (radiation) $27,662 (prostatectomy) and $11,134 (observation/surveillance). In our propensity score weighted regression model, the association between charges and ACO status was not significant, nor was the interaction between treatment type and costs. This was true both overall, and in a stratified analysis by treatment type.
Conclusions: There was no significant difference in Medicare spending on prostate cancer care based on provider ACO affiliation, regardless of treatment type. While the effects of ACOs on clinical care are complex, this study adds to a growing body of evidence suggesting that ACOs may fail to achieve significantly reduce costs in certain clinical settings such as prostate cancer.
Source of Funding: Brigham Research Institute, Bruce A. Beal and Robert L. Beal Surgical Fellowship, Conquer Cancer Foundation, Defense Health Agency, Intuitive Surgical, Prostate Cancer Foundation, Vattikuti Urology Institute. Maxine Sun is supported by an American Urologi