Adoption of New Risk Stratification Technologies Within US Hospital Referral Regions and Association With Prostate Cancer Management

Leapman, Michael; Wang, Rong; Park, Henry S.; Yu, James B.; Sprenkle, Preston; Dinan, Michaela A.; Ma, Xiaomei; Gross, Cary P.

doi:10.1001/jamanetworkopen.2021.28646

Cited by 17 publications

(14 citation statements)

References 40 publications

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“…Lastly, we did not examine the role of other tools that may modify surveillance, such as genomic testing, or how the results of testing may impact the intensity of surveillance. 32,33…”

Section: Resultsmentioning

confidence: 99%

Use of Monitoring Tests Among Patients With Localized Prostate Cancer Managed With Observation

et al. 2023

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Purpose:It is unknown whether compliance with recommended monitoring tests during observation of localized prostate cancer has changed over time.Materials and Methods:We performed a retrospective cohort study of Medicare beneficiaries diagnosed with low- or intermediate-risk prostate cancer in 2004-2016 who were initially managed with observation for a minimum of 12 months. The primary objective was to examine rates of PSA testing, prostate biopsy, and prostate MRI. We used multivariable mixed effects Poisson regression to determine whether rates of PSA testing and prostate biopsy increased over time. In addition, we identified clinical, sociodemographic, and provider factors associated with the frequency of monitoring tests during observation.Results:We identified 10,639 patients diagnosed at a median age of 73 (IQR 69-77) years. The median follow-up time was 4.3 (IQR 2.7-6.6) years after diagnosis. Among patients managed without treatment for 5 years, 98% received at ≥1 PSA test, 48.0% ≥1 additional prostate biopsy, and 31.0% ≥1 prostate MRI. Among patients managed with observation for ≥12 months, mixed effects Poisson regression revealed that rates of PSA testing and biopsy increased over time (per calendar year: RR 1.02, 95% CI: 1.02-1.03 and RR 1.10, 95% CI: 1.08-1.11, respectively). Clinical and sociodemographic factors including age, clinical risk, race/ethnicity, census tract poverty, and region were associated with rates of biopsy and PSA testing.Conclusions:Use of recommended monitoring tests including repeat prostate biopsy remains low among Medicare beneficiaries undergoing observation for low- and intermediate-risk prostate cancer.

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“…Lastly, we did not examine the role of other tools that may modify surveillance, such as genomic testing, or how the results of testing may impact the intensity of surveillance. 32,33…”

Section: Resultsmentioning

confidence: 99%

Use of Monitoring Tests Among Patients With Localized Prostate Cancer Managed With Observation

et al. 2023

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“…While readily available at most academic centers, mpMRI is less accessible in the community, with only 17% of patients undergoing prebiopsy mpMRI as of 2019. 9 With improving technology, there is great potential for improvement and expansion of these diagnostic tools. At the same time, microultrasound is an emerging technology that offers promise in the diagnostic setting.…”

Section: Screening/diagnosismentioning

confidence: 99%

Point of View: Innovation and Progress for Screening and Management of Localized Prostate Cancer: What an Exciting Time

Tosoian,

Yu,

Brisbane

2024

Journal of Urology

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“…Geographic variation in prostate cancer care delivery is well established and has a number of motivating factors. For example, other work has highlighted variation in the use of risk stratification with prostate magnetic resonance imaging and genomic testing 13 and active surveillance strategies for men with lower-risk prostate cancer. 14 In this case, possible facilitators of this variation include a lack of knowledge of the AUA policy brief recommending against its use or even financial incentives promoting inappropriate use in the face of that policy recommendation.…”

Section: Jama Network Open | Health Policymentioning

confidence: 99%

Trends in Urethral Suspension With Robotic Prostatectomy Procedures Following Medicare Payment Policy Changes

Patil

Davies

et al. 2022

JAMA Netw Open

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ImportanceIn 2016, the Centers for Medicare and Medicaid Services cut payments for robotic prostatectomy performed for Medicare beneficiaries. Although regulations mandate that billing for urethral suspension is only acceptable for preexisting urinary incontinence, reductions in reimbursement may incentivize billing for the use of this procedure in other scenarios.ObjectiveTo assess trends and geographic variations in payments for urethral suspension with robotic prostatectomy in the context of Medicare payment policy.Design, Setting, and ParticipantsThis US population-based retrospective cohort study analyzed data from the IBM MarketScan Commercial Claims and Encounters and Medicare Supplemental Database for men with employer-based insurance (primary commercial or Medicare supplemental coverage) who underwent robotic prostatectomy (Current Procedural Terminology [CPT] code 55866) between 2009 and 2019.ExposuresTime period and metropolitan statistical area of patient residence.Main Outcomes and MeasuresPayment for urethral suspension (CPT code 51990) with robotic prostatectomy.ResultsWe identified 87 774 men with prostate cancer treated with robotic prostatectomy; 3352 (3.8%) had undergone urethral suspension. The mean (SD) patient age was 59.7 (6.5) years; 16 870 patients (19.2%) had Medicare supplemental coverage. From 2015 to 2016, median payments for robotic prostatectomy changed by −$358 (−17.0%) for Medicare beneficiaries vs −$9 (0%) for commercially insured patients. With urethral suspension vs without, median (IQR) episode payments for robotic prostatectomy were higher for commercially insured men ($3678 [$3090-$4503] vs $3322 [$2601-$4306]) and Medicare beneficiaries ($2927 [$2450-$3909] vs $2379 [$2014-$3512]). Compared with men treated between 2013 and 2015, those treated between 2016 and 2017 were twice as likely to undergo urethral suspension (8.5% vs 4.1%; odds ratio, 2.17 [95% CI, 1.96-2.38]). The proportion of patients who underwent urethral suspension was stable for 2018 to 2019 and 2016 to 2017 (8.5% vs 9.0%; odds ratio, 1.06 [95% CI, 0.96-1.18]). From 2015 to 2019, the proportion of patients who underwent urethral suspension was highest in Charleston, South Carolina (92.0%), Knoxville, Tennessee (66.0%), and Columbia, South Carolina (58.0%). These regions neighbored high-volume areas without patients who underwent prostatectomy with urethral suspension (eg, 146 patients in Greenville, South Carolina, and 173 in Nashville, Tennessee).Conclusions and RelevanceIn this study, urethral suspension was associated with increased costs for patients with both commercial insurance and Medicare. Patients treated between 2016 and 2017 were more likely than those treated between 2013 and 2015 to undergo this procedure. Geographic variation in use exceeded what was expected for the preexisting condition for which billing is permitted for Medicare beneficiaries. Policy statements from professional societies highlighting appropriate billing for urethral suspension may have tempered, but not reversed, the broad adoption of this procedure.

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Adoption of New Risk Stratification Technologies Within US Hospital Referral Regions and Association With Prostate Cancer Management

Cited by 17 publications

References 40 publications

Use of Monitoring Tests Among Patients With Localized Prostate Cancer Managed With Observation

Use of Monitoring Tests Among Patients With Localized Prostate Cancer Managed With Observation

Point of View: Innovation and Progress for Screening and Management of Localized Prostate Cancer: What an Exciting Time

Trends in Urethral Suspension With Robotic Prostatectomy Procedures Following Medicare Payment Policy Changes

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