Urologist Practice Structure and Spending for Prostate Cancer Care

Area of Science:

• Health Services Research
• Oncology Health Economics
• Urology Practice Management

Background:

• Prostate cancer care costs represent a significant financial burden.
• Understanding factors influencing healthcare spending is crucial for cost containment.
• Urologist practice structure is a potential determinant of healthcare costs.

Purpose of the Study:

• To examine the association between urologist practice structure and healthcare spending for prostate cancer.
• To investigate the influence of multispecialty groups (MSGs), practice size, and intensity-modulated radiation therapy (IMRT) ownership on prostate cancer care costs.

Main Methods:

• Analysis of a 20% sample of fee-for-service Medicare beneficiaries diagnosed with prostate cancer (2011-2014).
• Identification of urologist practice type, size, and IMRT ownership using Healthcare Relational Spheres data.
• Generalized linear mixed models used to estimate Medicare payments in the year post-diagnosis, adjusted for patient and market characteristics.

Main Results:

• Medicare payments were significantly lower for men treated by urologists in MSGs ($19,181) compared to large single specialty groups ($22,366).
• Practices with IMRT ownership incurred significantly higher Medicare payments ($23,801) than non-owners ($20,162).
• These associations remained consistent in sensitivity analyses focused on radiotherapy and prostate cancer claims.

Conclusions:

• Urologist practice structure is demonstrably linked to prostate cancer care expenditures.
• Multispecialty groups are associated with the lowest Medicare payments per episode of care.
• Intensity-modulated radiation therapy ownership by urology practices correlates with the highest Medicare payments.