Urology practice consolidation and care for men with prostate cancer

PROJECT SUMMARY Management of prostate cancer remains a daunting challenge. Many men with prostate cancer will not die from it—even without any intervention—either due to competing risks of death or because of the indolent nature of their tumors. Yet, it is also the second most common cause of cancer death in men. Ongoing

uncertainty about whether and how to treat the disease has resulted in tremendous variation in its management and an outsized influence of non-clinical factors, such as financial incentives. A striking feature of the current healthcare landscape is the increasing consolidation of physician practices. The rapid shift towards

both vertical (i.e., hospital-physician partnerships) and horizontal (i.e., physician groups combining to form larger groups) integration of urology practices will almost certainly influence how prostate cancer is managed, though the implications are uncertain. Through centralization of care, and economies of scale that boost

infrastructure and resources for healthcare delivery, consolidation may result in better coordination of care, focused service lines, and robust quality improvement efforts. For men with prostate cancer, this could help ensure consistent implementation of guideline concordant active surveillance care, or appropriate monitoring of

targeted therapies for advanced disease. But consolidation also invariably reduces market competition, allowing such practices to negotiate higher third-party payments (i.e., commercial prices). The resulting financial incentives may promote utilization, fostering physician behavior that spills over to the Medicare

population. Independent of the nature of consolidation, its implications for access to prostate cancer care are also uncertain. On one hand, consolidation may impair access (e.g., requiring longer distance travel) for men previously served by acquired rural practices. On the other hand, it may improve access of these men to higher

quality, high volume physicians and hospitals. We therefore propose a study to better understand relationships between urology practice consolidation and prostate cancer care with the following aims: 1) To measure the effect of vertical urology practice consolidation on quality of prostate cancer care, 2) To assess the effect of

horizontal urology practice consolidation on quality of prostate cancer care, and 3) To determine the effect of urology practice consolidation on access to prostate cancer care. This study will shed light on relationships between physician practice consolidation, and delivery of care for an exceedingly common cancer. These

issues have been virtually unstudied to date and have implications for specialty care in other disciplines that are experiencing similar trends in consolidation. Findings will have real-world implications for patients, who are naturally interested in getting the best prostate cancer care.