MedicalResearch.com Interview with:
Danil V. Makarov, MD, MHS
Department of Urology and
Department of Population Health
New York University Langone School of Medicine
VA New York Harbor Healthcare System,
Robert F. Wagner Graduate School of Public Service
Cancer Institute, New York University School of Medicine, New York
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Reducing prostate cancer staging imaging for men with low-risk disease is an important national priority to improve widespread guideline-concordant practice, as determined by the National Comprehensive Cancer Network guidelines. It appears that prostate cancer imaging rates vary by several factors, including health care setting. Within Veterans Health Administration (VHA), physicians receive no financial incentive to provide more services. Outside VHA, the fee-for-service model used in Medicare may encourage provision of more healthcare services due to direct physician reimbursement.
In our study, we compared these health systems by investigating the association between prostate cancer imaging rates and a VA vs fee-for-service health care setting. We used novel methods to directly compare Veterans, Medicare Recipients, and Veterans that chose to receive care from both the VA at private facilities using Medicare insurance through the Choice Act with regard to rates of guideline-discordant imaging for prostate cancer.
We found that Medicare beneficiaries were significantly more likely to receive guideline-discordant prostate cancer imaging than men treated only in VA.
Moreover, we found that men with low-risk prostate cancer patients in the VA-only group had the lowest likelihood of guideline-discordant imaging, those in the VA and Medicare group had the next highest likelihood of guideline-discordant imaging (in the middle), and those in the Medicare-only group had the highest likelihood of guideline-discordant imaging.
MedicalResearch.com: What should readers take away from your report?
Response: The results of our study suggest that Veterans using the Choice Act to receive care in multiple health care systems are likely to experience more utilization of health care services without guarantee of improved quality of care. Access to health care by way of multiple health systems through the Choice Act may lead to receipt of guideline-discordant, unnecessary, and potentially harmful imaging tests.
We found that men with low-risk prostate cancer received more guideline-discordant imaging through Medicare, in a fee-for-service health system versus the VA, an integrated health system. This suggests that policies surrounding financial incentives for clinicians may contribute to provisions of unnecessary imaging tests and unnecessary health care spending.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future research, including interventions to improve guideline-concordant care for prostate cancer imaging, should consider varying contexts and unique setting of different health care systems. Future studies should also investigate the potential financial savings from an effort to improve appropriate use of imaging.
Disclosures: This research was funded by the US Department of Veterans Affairs.
Makarov DV, Ciprut S, Walter D, et al. Association Between Guideline-Discordant Prostate Cancer Imaging Rates and Health Care Service Among Veterans and Medicare Recipients. JAMA Network Open.2018;1(4):e181172. doi:10.1001/jamanetworkopen.2018.1172
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