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Background Accountable Care Organizations (ACOs) were established to improve care and outcomes for beneficiaries requiring highly coordinated, complex care. Our objective was to evaluate the association between hospital ACO participation and outcomes of major surgical oncology procedures. Methods We performed a retrospective cohort study of Medicare beneficiaries >65 years old undergoing a major surgical resection for colorectal, bladder, esophageal, kidney, liver, ovarian, pancreatic, lung or prostate cancer from 2011 through 2013. We implemented a difference-in-differences analysis comparing the post-implementation period (January 2013 through December 2013) to the baseline period (January 2011 through December 2012), to assess the impact of hospital ACO participation on 30-day mortality, complications, readmissions and length of stay. Results Among 384,519 patients undergoing major cancer surgery at 106 ACO hospitals and 2,561 control hospitals, we identified a 30-day mortality rate of 3.4%, readmission rate of 12.5%, complication rate of 43.8% and prolonged LOS rate of 10.0% in control hospitals, with similar rates in ACO hospitals. We noted secular trends, with reductions in perioperative adverse events in control hospitals between the baseline and post-implementation periods: mortality (0.1% percentage point reduction, p=0.19), readmissions (0.4%, p=0.001), complications (1.0%, p<0.001) and prolonged LOS (1.1%, p<0.001). After accounting for these secular trends, we identified no significant effect of hospital participation in an ACO on the frequency of perioperative outcomes (difference-in-differences estimator p-values 0.24–0.72). Conclusions Early hospital participation in the MSSP ACO program was not associated with greater reductions in adverse perioperative outcomes for patients undergoing major cancer surgery compared to control hospitals.

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Purpose We examined the frequency of follow-up prostate-specific antigen (PSA) testing and prostate biopsy among men managed with active surveillance (AS) in academic and community urology practices comprising the Michigan Urological Surgery Improvement Collaborative (MUSIC). Materials and Methods MUSIC is a consortium of 42 practices that maintains a prospective clinical registry with validated clinical data for all patients diagnosed with prostate cancer at participating sites. We identified all patients in MUSIC practices who entered AS and had at least two years of continuous follow-up. After determining the frequency of repeat PSA testing and prostate biopsy, we calculated rates of concordance with NCCN guideline recommendations (i.e., at least three PSA tests and one surveillance biopsy) both collaborative-wide and across individual practices. Results We identified 513 patients entering AS from 1/2012–9/2013 with at least two years of follow-up. Among the 431 men (84%) that remained on AS for two years, 132 (30.6%) had follow-up surveillance testing at a frequency that was concordant with NCCN recommendations. At a practice-level, the median rate of guideline concordant follow-up was 26.5% (range 10–67.5%, p<0.001). Among patients with discordant follow-up, the absence of follow-up biopsy was common and not significantly different across practices (median rate=82.0%, p=0.35). Conclusions Among diverse community and academic practices in Michigan, there is wide variation in the proportion of men on active surveillance that meet guideline recommendations for follow-up PSA testing and repeat biopsy. These data highlight the need for standardized AS pathways that emphasize the role for repeat surveillance biopsies.

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