Downstream tests, treatments, and annual direct payments in older men cared for by primary care providers with high or low prostate-specific antigen screening rates using 100 percent Texas U.S. Medicare public insurance claims data: a retrospective cohort study

Preeti Zanwar, Yu Li Lin, Yong Fang Kuo, James Goodwin

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: All authorities recommend against prostate specific antigen (PSA) screening in men 75 years and older. However, some primary care physicians (PCPs) continue to have high rates of PSA, with large variation in testing. We assessed the tests, treatments, and payments for prostate cancer care in men aged 75 or older who have PCPs with high or low PSA testing rates. Methods: We performed a retrospective cohort study using the 2010 Medicare beneficiaries aged 75 or older in Texas, United States who had no prostate cancer in 2007-2009 and had an identifiable PCP. We first identified high vs. low PSA testing PCPs, and then grouped older men in the two PCP groups. We determined health care visits to any provider and to urologists in office and outpatient settings. We estimated the direct medical payments for prostate cancer care for diagnostics, treatments and visits to providers in 2010-2011 using the generalized gamma model with log link function. Results: In multilevel, multivariable analyses, 25.4 % (n = 550) of PCPs had PSA testing rates in men aged 75 or older that were significantly higher than the mean rate of all 2,169 Texas PCPs; 29.4 % (n = 638) had rates that were significantly lower. In all, 22,853 vs. 23,929 older men were cared for by PCPs with high vs. low testing rates. Older men cared for by high PSA rate PCPs were more likely to receive a PSA test (OR 3.64, 95 % CI 3.48-3.80), a biopsy (OR 1.16, 95 % CI 1.02-1.31), an ultrasound (OR 1.19, 95 % CI 1.07-1.32) or any radiation treatment (OR 1.31, 95 % CI 1.03-1.66) than men cared for by low PSA rate PCPs. Men with high PSA rate PCPs were 1.21 (95 % CI 1.05-1.39) times more likely to have such outpatient visits. The average annual adjusted Medicare payments for prostate cancer care was $25.60 higher for patients cared for by PCPs with high PSA test rates. Conclusions: Older men seeing PCPs with high rates of PSA testing undergo more testing and treatments for prostate cancer, with higher Medicare insurance payments. Future studies are needed to delineate whether men seeing PCPs with low testing rates likely received PSA tests from other providers.

Original languageEnglish (US)
Article number1265
JournalBMC Health Services Research
Volume16
Issue number1
DOIs
StatePublished - Jan 15 2016

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Primary Care Physicians
Prostate-Specific Antigen
Medicare
Insurance
Primary Health Care
Cohort Studies
Retrospective Studies
Prostatic Neoplasms
Therapeutics
Outpatients
Multilevel Analysis

Keywords

  • Cancer screening
  • Costs and cost analysis
  • Economic models
  • Geriatrics
  • Health policy
  • Health services
  • Healthcare providers
  • Medicare
  • Prostate cancer
  • Prostate-specific antigen

ASJC Scopus subject areas

  • Health Policy

Cite this

@article{c30c7f08dd8a4fa39600339c4e141dc0,
title = "Downstream tests, treatments, and annual direct payments in older men cared for by primary care providers with high or low prostate-specific antigen screening rates using 100 percent Texas U.S. Medicare public insurance claims data: a retrospective cohort study",
abstract = "Background: All authorities recommend against prostate specific antigen (PSA) screening in men 75 years and older. However, some primary care physicians (PCPs) continue to have high rates of PSA, with large variation in testing. We assessed the tests, treatments, and payments for prostate cancer care in men aged 75 or older who have PCPs with high or low PSA testing rates. Methods: We performed a retrospective cohort study using the 2010 Medicare beneficiaries aged 75 or older in Texas, United States who had no prostate cancer in 2007-2009 and had an identifiable PCP. We first identified high vs. low PSA testing PCPs, and then grouped older men in the two PCP groups. We determined health care visits to any provider and to urologists in office and outpatient settings. We estimated the direct medical payments for prostate cancer care for diagnostics, treatments and visits to providers in 2010-2011 using the generalized gamma model with log link function. Results: In multilevel, multivariable analyses, 25.4 {\%} (n = 550) of PCPs had PSA testing rates in men aged 75 or older that were significantly higher than the mean rate of all 2,169 Texas PCPs; 29.4 {\%} (n = 638) had rates that were significantly lower. In all, 22,853 vs. 23,929 older men were cared for by PCPs with high vs. low testing rates. Older men cared for by high PSA rate PCPs were more likely to receive a PSA test (OR 3.64, 95 {\%} CI 3.48-3.80), a biopsy (OR 1.16, 95 {\%} CI 1.02-1.31), an ultrasound (OR 1.19, 95 {\%} CI 1.07-1.32) or any radiation treatment (OR 1.31, 95 {\%} CI 1.03-1.66) than men cared for by low PSA rate PCPs. Men with high PSA rate PCPs were 1.21 (95 {\%} CI 1.05-1.39) times more likely to have such outpatient visits. The average annual adjusted Medicare payments for prostate cancer care was $25.60 higher for patients cared for by PCPs with high PSA test rates. Conclusions: Older men seeing PCPs with high rates of PSA testing undergo more testing and treatments for prostate cancer, with higher Medicare insurance payments. Future studies are needed to delineate whether men seeing PCPs with low testing rates likely received PSA tests from other providers.",
keywords = "Cancer screening, Costs and cost analysis, Economic models, Geriatrics, Health policy, Health services, Healthcare providers, Medicare, Prostate cancer, Prostate-specific antigen",
author = "Preeti Zanwar and Lin, {Yu Li} and Kuo, {Yong Fang} and James Goodwin",
year = "2016",
month = "1",
day = "15",
doi = "10.1186/s12913-016-1265-1",
language = "English (US)",
volume = "16",
journal = "BMC Health Services Research",
issn = "1472-6963",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Downstream tests, treatments, and annual direct payments in older men cared for by primary care providers with high or low prostate-specific antigen screening rates using 100 percent Texas U.S. Medicare public insurance claims data

T2 - a retrospective cohort study

AU - Zanwar, Preeti

AU - Lin, Yu Li

AU - Kuo, Yong Fang

AU - Goodwin, James

PY - 2016/1/15

Y1 - 2016/1/15

N2 - Background: All authorities recommend against prostate specific antigen (PSA) screening in men 75 years and older. However, some primary care physicians (PCPs) continue to have high rates of PSA, with large variation in testing. We assessed the tests, treatments, and payments for prostate cancer care in men aged 75 or older who have PCPs with high or low PSA testing rates. Methods: We performed a retrospective cohort study using the 2010 Medicare beneficiaries aged 75 or older in Texas, United States who had no prostate cancer in 2007-2009 and had an identifiable PCP. We first identified high vs. low PSA testing PCPs, and then grouped older men in the two PCP groups. We determined health care visits to any provider and to urologists in office and outpatient settings. We estimated the direct medical payments for prostate cancer care for diagnostics, treatments and visits to providers in 2010-2011 using the generalized gamma model with log link function. Results: In multilevel, multivariable analyses, 25.4 % (n = 550) of PCPs had PSA testing rates in men aged 75 or older that were significantly higher than the mean rate of all 2,169 Texas PCPs; 29.4 % (n = 638) had rates that were significantly lower. In all, 22,853 vs. 23,929 older men were cared for by PCPs with high vs. low testing rates. Older men cared for by high PSA rate PCPs were more likely to receive a PSA test (OR 3.64, 95 % CI 3.48-3.80), a biopsy (OR 1.16, 95 % CI 1.02-1.31), an ultrasound (OR 1.19, 95 % CI 1.07-1.32) or any radiation treatment (OR 1.31, 95 % CI 1.03-1.66) than men cared for by low PSA rate PCPs. Men with high PSA rate PCPs were 1.21 (95 % CI 1.05-1.39) times more likely to have such outpatient visits. The average annual adjusted Medicare payments for prostate cancer care was $25.60 higher for patients cared for by PCPs with high PSA test rates. Conclusions: Older men seeing PCPs with high rates of PSA testing undergo more testing and treatments for prostate cancer, with higher Medicare insurance payments. Future studies are needed to delineate whether men seeing PCPs with low testing rates likely received PSA tests from other providers.

AB - Background: All authorities recommend against prostate specific antigen (PSA) screening in men 75 years and older. However, some primary care physicians (PCPs) continue to have high rates of PSA, with large variation in testing. We assessed the tests, treatments, and payments for prostate cancer care in men aged 75 or older who have PCPs with high or low PSA testing rates. Methods: We performed a retrospective cohort study using the 2010 Medicare beneficiaries aged 75 or older in Texas, United States who had no prostate cancer in 2007-2009 and had an identifiable PCP. We first identified high vs. low PSA testing PCPs, and then grouped older men in the two PCP groups. We determined health care visits to any provider and to urologists in office and outpatient settings. We estimated the direct medical payments for prostate cancer care for diagnostics, treatments and visits to providers in 2010-2011 using the generalized gamma model with log link function. Results: In multilevel, multivariable analyses, 25.4 % (n = 550) of PCPs had PSA testing rates in men aged 75 or older that were significantly higher than the mean rate of all 2,169 Texas PCPs; 29.4 % (n = 638) had rates that were significantly lower. In all, 22,853 vs. 23,929 older men were cared for by PCPs with high vs. low testing rates. Older men cared for by high PSA rate PCPs were more likely to receive a PSA test (OR 3.64, 95 % CI 3.48-3.80), a biopsy (OR 1.16, 95 % CI 1.02-1.31), an ultrasound (OR 1.19, 95 % CI 1.07-1.32) or any radiation treatment (OR 1.31, 95 % CI 1.03-1.66) than men cared for by low PSA rate PCPs. Men with high PSA rate PCPs were 1.21 (95 % CI 1.05-1.39) times more likely to have such outpatient visits. The average annual adjusted Medicare payments for prostate cancer care was $25.60 higher for patients cared for by PCPs with high PSA test rates. Conclusions: Older men seeing PCPs with high rates of PSA testing undergo more testing and treatments for prostate cancer, with higher Medicare insurance payments. Future studies are needed to delineate whether men seeing PCPs with low testing rates likely received PSA tests from other providers.

KW - Cancer screening

KW - Costs and cost analysis

KW - Economic models

KW - Geriatrics

KW - Health policy

KW - Health services

KW - Healthcare providers

KW - Medicare

KW - Prostate cancer

KW - Prostate-specific antigen

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U2 - 10.1186/s12913-016-1265-1

DO - 10.1186/s12913-016-1265-1

M3 - Article

C2 - 26772175

AN - SCOPUS:84954445334

VL - 16

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

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M1 - 1265

ER -