Brent K Hollenbeck1, Samuel R Kaufman2, Phyllis Yan2, Lindsey A Herrel2, Tudor Borza2, Florian R Schroeck3, Bruce L Jacobs4, Ted A Skolarus2, Vahakn B Shahinian5. 1. Dow Division for Health Services Research, Department of Urology University of Michigan, Ann Arbor, MI, USA. Electronic address: bhollen@umich.edu. 2. Dow Division for Health Services Research, Department of Urology University of Michigan, Ann Arbor, MI, USA. 3. The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH, USA. 4. The Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA. 5. Kidney Epidemiology Cost Center, University of Michigan, Ann Arbor, MI, USA.
Abstract
BACKGROUND: Prostate cancer treatment is a significant source of morbidity and spending. Some men with prostate cancer, particularly those with significant health problems, are unlikely to benefit from treatment. OBJECTIVE: To assess relationships between financial incentives associated with urologist ownership of radiation facilities and treatment for prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort of Medicare beneficiaries with prostate cancer diagnosed between 2010 and 2012. Patients were further classified by their risk of dying from noncancer causes in the 10 yr following their cancer diagnosis by using a mortality model derived from comparable patients known to be cancer-free. INTERVENTION: Urologists were categorized by their practice affiliation (single-specialty groups by size, multispecialty group) and ownership of a radiation facility. OUTCOME MEASUREMENTS AND ANALYSIS: Use of intensity-modulated radiation therapy (IMRT) and use of any treatment within 1 yr of diagnosis. Generalized estimating equations were used to adjust for patient differences. RESULTS: Among men with newly diagnosed prostate cancer, use of IMRT ranged from 24% in multispecialty groups to 37% in large urology groups (p<0.001). Patients managed in groups with IMRT ownership (n=5133) were more likely to receive IMRT than those managed by single-specialty groups without ownership (43% vs 30%, p<0.001), regardless of group size. Among patients with a very high risk (> 75%) of noncancer mortality within 10 yr of diagnosis, both IMRT use (42% vs 26%, p<0.001) and overall treatment (53% vs 44%, p<0.001) were more likely in groups with ownership than in those without, respectively. CONCLUSIONS: Urologists practicing in single-specialty groups with an ownership interest in radiation therapy are more likely to treat men with prostate cancer, including those with a high risk of noncancer mortality. PATIENT SUMMARY: We assessed treatment for prostate cancer among urologists with varying levels of financial incentives favoring intervention. Those with stronger incentives, as determined by ownership interest in a radiation facility, were more likely to treat prostate cancer, even when treatment was unlikely to provide a survival benefit to the patient.
BACKGROUND:Prostate cancer treatment is a significant source of morbidity and spending. Some men with prostate cancer, particularly those with significant health problems, are unlikely to benefit from treatment. OBJECTIVE: To assess relationships between financial incentives associated with urologist ownership of radiation facilities and treatment for prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort of Medicare beneficiaries with prostate cancer diagnosed between 2010 and 2012. Patients were further classified by their risk of dying from noncancer causes in the 10 yr following their cancer diagnosis by using a mortality model derived from comparable patients known to be cancer-free. INTERVENTION: Urologists were categorized by their practice affiliation (single-specialty groups by size, multispecialty group) and ownership of a radiation facility. OUTCOME MEASUREMENTS AND ANALYSIS: Use of intensity-modulated radiation therapy (IMRT) and use of any treatment within 1 yr of diagnosis. Generalized estimating equations were used to adjust for patient differences. RESULTS: Among men with newly diagnosed prostate cancer, use of IMRT ranged from 24% in multispecialty groups to 37% in large urology groups (p<0.001). Patients managed in groups with IMRT ownership (n=5133) were more likely to receive IMRT than those managed by single-specialty groups without ownership (43% vs 30%, p<0.001), regardless of group size. Among patients with a very high risk (> 75%) of noncancer mortality within 10 yr of diagnosis, both IMRT use (42% vs 26%, p<0.001) and overall treatment (53% vs 44%, p<0.001) were more likely in groups with ownership than in those without, respectively. CONCLUSIONS: Urologists practicing in single-specialty groups with an ownership interest in radiation therapy are more likely to treat men with prostate cancer, including those with a high risk of noncancer mortality. PATIENT SUMMARY: We assessed treatment for prostate cancer among urologists with varying levels of financial incentives favoring intervention. Those with stronger incentives, as determined by ownership interest in a radiation facility, were more likely to treat prostate cancer, even when treatment was unlikely to provide a survival benefit to the patient.
Authors: Bruce L Jacobs; Yun Zhang; Florian R Schroeck; Ted A Skolarus; John T Wei; James E Montie; Scott M Gilbert; Seth A Strope; Rodney L Dunn; David C Miller; Brent K Hollenbeck Journal: JAMA Date: 2013-06-26 Impact factor: 56.272
Authors: Brent K Hollenbeck; Maggie J Bierlein; Samuel R Kaufman; Lindsey Herrel; Ted A Skolarus; David C Miller; Vahakn B Shahinian Journal: Am J Manag Care Date: 2016-09 Impact factor: 2.229
Authors: John M Hollingsworth; Zaojun Ye; Seth A Strope; Sarah L Krein; Ann T Hollenbeck; Brent K Hollenbeck Journal: Health Aff (Millwood) Date: 2010-04 Impact factor: 6.301
Authors: A V Diez Roux; S S Merkin; D Arnett; L Chambless; M Massing; F J Nieto; P Sorlie; M Szklo; H A Tyroler; R L Watson Journal: N Engl J Med Date: 2001-07-12 Impact factor: 91.245
Authors: B J Hillman; G T Olson; P E Griffith; J H Sunshine; C A Joseph; S D Kennedy; W R Nelson; L B Bernhardt Journal: JAMA Date: 1992-10-21 Impact factor: 56.272
Authors: Parth K Modi; Lindsey A Herrel; Samuel R Kaufman; Phyllis Yan; Tudor Borza; Ted A Skolarus; Florian R Schroeck; Brent K Hollenbeck; Vahakn B Shahinian Journal: Urology Date: 2019-04-25 Impact factor: 2.649
Authors: Parth K Modi; Phyllis Yan; Brent K Hollenbeck; Samuel R Kaufman; Tudor Borza; Ted A Skolarus; Florian R Schroeck; Andrew M Ryan; Vahakn B Shahinian; Lindsey A Herrel Journal: Urol Pract Date: 2020-09-01
Authors: Brent K Hollenbeck; Rodney L Dunn; Devraj Sukul; Parth K Modi; Brahmajee K Nallamothu; Ananda Sen; Julie P Bynum Journal: J Am Geriatr Soc Date: 2021-09-08 Impact factor: 7.538
Authors: Parth K Modi; Samuel R Kaufman; Megan V Caram; Chad Ellimoottil; Vahakn B Shahinian; Brent K Hollenbeck Journal: Urology Date: 2019-01-22 Impact factor: 2.649
Authors: Terry Zwiep; San Hilalion Ahn; Jamie Brehaut; Fady Balaa; Daniel I McIsaac; Susan Rich; Tom Wallace; Husein Moloo Journal: BMJ Open Date: 2021-01-08 Impact factor: 2.692
Authors: Lauren P Wallner; Mousumi Banerjee; David Reyes-Gastelum; Ann S Hamilton; Kevin C Ward; Carrie Lubitz; Sarah T Hawley; Megan R Haymart Journal: J Clin Endocrinol Metab Date: 2021-05-13 Impact factor: 5.958
Authors: Kathryn A Marchetti; Mary Oerline; Brent K Hollenbeck; Samuel R Kaufman; Ted A Skolarus; Vahakn B Shahinian; Megan E V Caram; Parth K Modi Journal: Urology Date: 2021-02-19 Impact factor: 2.633
Authors: Bruce L Jacobs; Jonathan G Yabes; Samia H Lopa; Dwight E Heron; Chung-Chou H Chang; Justin E Bekelman; Joel B Nelson; Julie P W Bynum; Amber E Barnato; Jeremy M Kahn Journal: Urology Date: 2020-01-13 Impact factor: 2.649