Urologist Participation in Medicare Shared Savings Program Accountable Care Organizations (ACOs)

Abstract

Structured Abstract Objectives To understand the current role of urologists in Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) and the organizational characteristics of ACOs with participating urologists. Methods Using 2012–2013 Medicare data and the National Provider Identifier (NPI) Database, we classified each urologist in the U.S. and Puerto Rico as either an MSSP ACO-participant or non-participating provider. We then examined the distribution of ACO-participating urologists across the U.S. and among the first 220 MSSP ACOs. We also compared the characteristics of ACOs with and without participating urologists. Results Among 11,084 identified urologists, 1,118 (10%) were MSSP ACO-participants. ACO-participating urologists practiced more frequently in the Northeast and Midwest (p<0.001), and were more commonly female (10% vs. 8%, p=0.003). At an organizational level, only 110 (50%) of the initial MSSP ACOs included at least one urologist; among this group, the number of participating urologists ranged from 1 to 55. ACOs with one or more participating urologist were larger organizations, with respect to both the number of assigned beneficiaries and the number of providers per 1,000 beneficiaries (p<0.001 for each comparison). The patient populations served by ACOs with and without urologists were similar (p>0.05 for each comparison). Conclusions A modest percentage of urologists participate in MSSP ACOs, although many of these organizations still lack any formal involvement by urological surgeons. Without such participation, improving the coordination, quality, and cost of urologic care for Medicare beneficiaries may be more challenging.

Early effect of Medicare Shared Savings Program accountable care organization participation on prostate cancer care

“…The question of whether Shared Savings ACOs can translate this improved quality and cost savings into prostate cancer care remains unclear. Prostate cancer is managed largely by specialists who have low ACO involvement and whose financial incentives may not align with those of the ACO. However, because ACOs are responsible for all spending for their assigned beneficiaries regardless of where services are provided, primary care physicians may influence the ultimate treatment decision by preferentially referring patients to specialists whose practice is more aligned with the ACO objectives.…”

Variation in prostate cancer treatment and spending among Medicare shared savings program accountable care organizations

“…The primary exposure was the extent of urologist engagement by the beneficiary's ACO. Previous studies have found that only 10% of urologists participate in Medicare Shared Savings Program ACOs, and only 50% of ACOs include a urologist . We postulated that in order for an ACO to affect prostate cancer care, it would have to both include participating urologists and preferentially direct referrals to those urologists.…”

“…Previous studies have found that only 10% of urologists participate in Medicare Shared Savings Program ACOs, and only 50% of ACOs include a urologist. 14 We postulated that in order for an ACO to affect prostate cancer care, it would have to both include participating urologists and preferentially direct referrals to those urologists. Therefore, we constructed a variable to characterize the strength of each ACO's engagement with participating urologists.…”

Alternative payment models and urology

“…Only 10% of urologists (1118) are MSSP ACO participants[14]. However, 50% of the original MSSP ACOs had at least one urologist participating its organization (and up to 55).…”

“…However, 50% of the original MSSP ACOs had at least one urologist participating its organization (and up to 55). Groups that included urology providers had more total number of providers and covered a larger number of beneficiaries compared to those that did not include an urologist[14]. While most APMs are currently primary care focused, CMS’ goal is to have more models applicable to specialty groups in the future[7].…”