Use of observation for PCa varies widely among urologists

A CMS quality measure needs to be bidirectional, “specifying a rate of observation for low-risk disease and a rate of treatment for high-risk disease,” researchers say.

Analyses of data on the management of localized prostate cancer reveal individual providers vary substantially in their use of observation for men with low-risk disease. More importantly, the research also shows a statistically significant positive correlation at the provider level in the predictive probabilities of observation for managing low-risk and high-risk disease.

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In other words, it determined that urologists tend to use observation or treatment for localized prostate cancer, regardless of disease risk.

The study was reported by investigators from Vanderbilt University Medical Center, Nashville, TN at the AUA annual meeting in San Diego.

Dr. Tyson“These findings suggest that when the Centers for Medicare & Medicaid Services rolls out measures for the Merit-Based Incentive Payment System (MIPS) to limit inappropriate resource use for men with low-risk localized prostate cancer, it will be important to do more than simply mandate a standard resource-use pattern of observation because it may impede access to care for high-risk patients,” said first author Mark D. Tyson, MD.

“We suggest that a quality measure needs to be bidirectional, specifying a rate of observation for low-risk disease and a rate of treatment for high-risk disease,” he told Urology Times.

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Individual urologist use of observation for men with localized prostate cancer was quantified by linking data from the Surveillance, Epidemiology, and End-Results program to Medicare claims data, recognizing that MIPS quality and resource use measures will be derived from claims-based data, Dr. Tyson told Urology Times.

Next: Study included data from 57,669 patients

The study, covering the period from 2004 to 2009, included data from 57,669 patients diagnosed by 1,884 urologists who diagnosed at least one low-risk, intermediate-risk, and high-risk patient during the study period. Patients with low-risk, intermediate-risk, and high-risk disease comprised 35.6%, 38.7%, and 25.7% of the sample, respectively.

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Rates of observation for the low-risk, intermediate-risk, and high-risk strata were 27%, 13%, and 7%, respectively. Looking at individual provider data, the rate of observation for men with low-risk disease ranged between 5% and 70%.

“No matter what is being studied in medicine, this level of variation in practice prompts concern for the underlying clinical rationale of the services being delivered,” said Dr. Tyson.

There was less variation in rates of observation among individual providers for men with intermediate-risk and high-risk disease.

In a sensitivity analysis, evaluation of the correlation between provider-level predicted probabilities of observation for low-risk and high-risk localized prostate cancer was performed using data for 480 “expert urologists,” defined as those diagnosing more than 10 patients in each of the risk strata. The correlation between the predicted probability of observation for low-risk and high-risk disease was even stronger in this subset of providers.

As a follow-on study, Dr. Tyson said he would like to see if the same practice patterns persist looking at a more contemporary cohort of Medicare patients.