A Payment Incentive to Improve Confirmatory Testing in Men With Prostate Cancer.

Importance: Among men with favorable-risk (ie, low-risk or favorable intermediate-risk) prostate cancer, confirmatory testing substantially improves the detection of aggressive cancers that may merit treatment instead of conservative management. Despite guideline recommendations, confirmatory testing is inconsistently used, and more than half of men do not receive it. Value-based interventions and payment incentives may improve care quality by motivating adherence to guideline-concordant care.

Anticipated Out-Of-Pocket Costs and Prostate Cancer Management Among Men With Commercial Insurance.

Introduction: Men with newly diagnosed prostate cancer often appropriately elect for either immediate treatment or conservative management. The out-of-pocket costs they face vary by management strategy, with immediate treatment often superseding those of conservative management, potentially influencing patient decisions. We estimated the anticipated out-of-pocket costs that commercially insured men with newly diagnosed prostate cancer face and measured their association with immediate treatment.

Integration of Advanced Practice Providers into Independent Surgical Groups.

Background: Nurse practitioners and physician assistants are increasingly employed to extend surgeon capacity and access. However, their roles and the extent to which their deployment aligns with unmet need is unknown.

Study Design: Medicare data was used to identify patients managed by surgical groups (urologists, and orthopedic, general, and cardiothoracic surgeons) from 2010-2020.

Association of Pathways to Success Launch With Quality inBeneficiaries With Traditional Medicare.

Objective: To evaluate the association between implementation of "Pathways to Success" and quality among beneficiaries cared for in Shared Savings Program accountable care organizations (ACOs).

Study Setting And Design: Medicare initiated "Pathways to Success" in 2019 that required upside-risk only ACOs in Shared Savings Program to transition to a two-sided risk model and prior two-sided ACOs to assume even greater financial responsibility. We examined the association between Pathways and ACO-targeted (hospitalizations for congestive heart failure [CHF] and all-cause 30-day readmissions) and nontargeted (all-cause emergency department visits without hospitalization for CHF and hospital observation stays) quality measures, using a difference-in-differences framework.

Effects of Maryland's All-Payer Model on elective joint replacement surgery.

Objective: To evaluate the Maryland All-Payer Model's impact on the rate of elective major joint replacement surgery.

Study Design: A retrospective cohort study of patients in Maryland undergoing elective major joint replacement between 2011 and 2018 was performed using a 20% fee-for-service Medicare sample in a difference-in-difference framework with patients undergoing hip fracture repair serving as controls.

Methods: Among Maryland residents, there were 7147 Medicare fee-for-service patients undergoing elective major joint replacement and 1008 Medicare fee-for-service beneficiaries undergoing hip fracture repair.

Spillover Effects of Medicare Advantage on Traditional Medicare Beneficiaries With Prostate Cancer.

Introduction: Medicare Advantage (MA) managed care plans, now chosen by 51% of Medicare beneficiaries, are incentivized to constrain healthcare spending and utilization, a shift in financial incentives compared to Traditional Medicare's fee-for-service payment model. Beyond its primary beneficiaries, MA's mechanisms to constrain utilization may impact Traditional Medicare beneficiaries with prostate cancer through "spillover" effects on physician behavior.

Methods: From a 20% sample of Medicare claims, we identified patients diagnosed with prostate cancer from 2016 to 2019.

Early Effects of Pathways to Success on Utilization in Traditional Medicare.

Objective: To evaluate the early effects of Pathways to Success implementation on utilization, as measured by quarterly price-standardized Medicare spending per beneficiary.

Study Setting And Design: This study was a nationwide retrospective cohort analysis of Traditional Medicare beneficiaries. The primary outcome was overall utilization, as measured by adjusted quarterly price standardized spending per beneficiary.

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 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.

Exit Rates of Accountable Care Organizations That Serve High Proportions of Beneficiaries of Racial and Ethnic Minority Groups.

Importance: The Medicare Shared Savings Program provides financial incentives for accountable care organizations (ACOs) to reduce costs of care. The structure of the shared savings program may not adequately adjust for challenges associated with caring for patients with high medical complexity and social needs, a population disproportionately made up of racial and ethnic minority groups. If so, ACOs serving racial and ethnic minority groups may be more likely to exit the program, raising concerns about the equitable distribution of potential benefits from health care delivery reform efforts.