Veterans who utilize Medicare and other fee-for-service health systems for prostate cancer care are more likely to receive guideline-discordant imaging than those treated at the Veterans Health Administration (VA), according to research published Aug. 17 in JAMA Network Open.
These patients with low-risk prostate cancer could experience more unnecessary screenings than needed, wrote lead author Danil Makarov, MD, a urologist at NYU Langone Health. This is important as the U.S. government continues to find ways to allow veterans receive care outside the VA system.
“Prostate cancer imaging rates appear to vary by healthcare setting. With the recent extension of the Veterans Access, Choice and Accountability Act [the Choice Act], the government has provided funds for veterans to seek care outside the VA,” Makarov et al. wrote. “It is important to understand the difference in imaging rates and subsequent differences in patterns of care in the VA versus a traditional fee-for-service setting such as Medicare.”
To assess the association between prostate cancer imaging rates and a VA versus fee-for-service healthcare setting, Makarov and colleagues analyzed data from 98,867 men (average age 70 years, 77.4 percent white) who received a prostate cancer diagnosis from Jan. 2004 through March 2008.
Data was collected from the VA Central Cancer Registry and linked to Medicare claims and utilization records as well as the Surveillance, Epidemiology and End Results Program (SEER).
The researchers then organized the data into three groups: men with prostate cancer who used only Medicare (57.3 percent), those who used only the VA (28.1 percent), and those who used both the VA and Medicare (14.5 percent) for diagnosis and treatment.
The team also determined whether patients with low-risk prostate cancer received care that met the National Comprehensive Cancer Network (NCCN) guidelines and determined the appropriateness of their radionuclide bone scans, CT scans or MRI exams. Men who meet these imaging test requirements have high-risk prostate cancer, according to the researchers.
The researchers found that among men with low-risk prostate cancer, the Medicare-only group had the highest rate of guideline-discordant imaging (52.5 percent), followed by the VA and Medicare group (50.9 percent) and the VA-only group (45.9 percent). Additionally, the VA and Medicare group and the VA-only group were less likely to receive guideline-discordant imaging than the Medicare-only group.
The research reveals significant differences between integrated and fee-for-service health systems regarding imaging guideline concordance and quality of care, the researchers explained, as those using the Choice Act were not guaranteed an improved quality of care.
A recent graduate from Dominican University (IL) with a bachelor’s in journalism, Melissa joined TriMed’s Chicago team in 2017 covering all aspects of health imaging. She’s a fan of singing and playing guitar, elephants, a good cup of tea, and her golden retriever Cooper.