ACO enrollment associated with improved appropriateness of breast, colorectal cancer screening

Enrollment in a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) is associated with improvements in appropriateness of breast and colorectal screening, according to a new study published in JAMA Internal Medicine. It was also associated with a reduction in the number of patients being screened for prostate cancer.

The authors studied Medicare data from 2007 to 2014, tracking changes in screening and whether those changes were related to appropriateness. Among Medicare beneficiaries, enrollment in a MSSP ACO was associated with a decrease in breast cancer screening among women 75 years or older. This led to an overall reduction in overscreening. Enrollment was also associated with an increase in colorectal screening among appropriate screening candidates.

On the other hand, enrollment in a MSSP ACO was associated with a reduction in prostate cancer screening among appropriate screening candidates.

“Observed reductions in breast cancer overscreening coupled with improvements in colorectal cancer screening may indeed reflect migration toward “optimal” population-level screening rates as a result of the combination of quality measurement and financial accountability associated with ACO implementation,” wrote lead author Matthew J. Resnick, MD, MPH, MMHC, of Vanderbilt University Medical Center in Nashville, and colleagues. “Interestingly, ACO enrollment was associated with a significant reduction in prostate cancer screening, and the observed reduction occurred in both appropriate and inappropriate populations.”

Looking closer at the impact on prostate cancer screening, Resnick et al. suggested the decrease in screening may be related to providers working to reduce overdiagnosis and overtreatment. More research is needed, they added.

“There remains no meaningful estimate of the ‘optimal’ rate of population-level prostate cancer screening, and as such, whether the observed reductions in screening associated with ACO enrollment reflect movement in the right or wrong direction remains unknown,” the authors wrote. “Certainly, qualitative work to characterize the implications of these findings will be essential as we seek to understand the intended and unintended consequences of payment innovations.”