Article Series
PCEC Policy Position on Care Coordination
Care coordination is an emerging issue in the health landscape that will directly impact the treatment of prostate cancer, including timely referrals and physician reimbursement, early detection of disease and the treatment of other prostate conditions.
Too often, primary care doctors do not receive the complete picture when it comes to their patients’ health. This can occur when patients are referred to a specialist (urologist or oncologist) who makes treatment decisions without informing the primary care doctor. This leaves the primary care doctor unaware of new medications or procedures ordered by the specialist. Because of the “gap” in communication and care coordination, patients are put in a vulnerable position that could jeopardize their health.
Additionally, due to the financial incentives built into our current healthcare system, medical professionals, including urologists, can be reluctant to refer patients to other specialists, like oncologists. More and more often, urologists are providing radiation therapy in their own offices or in centers that they own instead of referring patients with prostate cancer to oncologists, since Medicare will pay up to $45,000 per patient treated. This type of treatment has increased by nearly 8 percent each year since 2003 at the expense of other, cheaper treatments like radiation seed implants and “watchful waiting.” As a result, we estimate that about 30 percent of men treated for prostate cancer receive unnecessary radiation.
Taken together, it is distressing that patients are not always receiving the most appropriate care available. This is especially relevant for men at risk for prostate conditions as:
- Prostate condition risk and incidence increases with age, and older patients often experience co-morbidities that require specialized care (i.e., patients are likely to be seeing a greater number of providers).
- The first sign of a prostate condition can often be identified through routine medical examinations by primary care doctors, but might require specialized care.
- Prostate cancer often requires multiple caregivers, including a primary care physician or urologist, as well as an oncologist.
Implementation of the care coordination model will improve practices between healthcare providers (and between doctors and patients) and will de-incentivize the predatory practices currently being employed by some specialists. Ensuring care is provided in a timely and efficient manner by the right health professional will help lead to improvements in patient health, enable patients to become active, informed partners in their healthcare decisions and discourage wasteful spending in the healthcare system.
Tools to Improve Care Coordination
Recognition of these challenges has given way to a variety of proposals for change to the healthcare delivery system. In fact, the argument for better care coordination is so strong that several potential solutions were incorporated into the healthcare reform legislation enacted into law in March 2010. Below is an overview of mechanisms proposed within the law that have potential to improve care coordination as it relates to prostate care. Of note, as the government and other groups spearhead pilot programs to better understand the full impact and value of these mechanisms, specifics regarding the definition and parameters will continue to evolve.
Medical Homes – a medical office or clinic that assigns a point person and a team of health professionals to offer personalized, coordinated primary healthcare to each patient. The medical home is paid a fee per patient by insurers, which covers the range of services essential to providing high quality healthcare, including ongoing communication with a patient’s specialist.
Accountable Care Organizations (ACO) – physician groups and practices can form ACOs wherein participating providers agree to manage the full range of patient care – from hospital to home to doctor’s offices, including specialist care – for a fixed payment per patient.
Electronic Health Records (EHR) – a way to capture patient health information – including demographics, medical history, vital signs, progress notes and laboratory data – in an electronic format so that is more easily accessed and shared among providers. By providing access to the full spectrum of medical records, EHR can help providers understand and treat a patient based on their full medical profile.
PCEC’s Position on Care Coordination
PCEC supports initiatives and programs designed to improve care coordination that are consistent with the following principles:
- Care for prostate conditions should be comprehensive, well-coordinated and accessible to patients when and where they need it.
- Specialists, including urologists and oncologists, should be appropriately incentivized to refer patients to other specialists and physicians to effectively manage a patient’s prostate health.
Based on these principles, PCEC supports and encourages:
- Implementation of both medical home and accountable care organization pilot projects that will incentivize prostate care providers (i.e., urologists and oncologists) to provide the appropriate care, including referrals to other health professionals and ongoing communication with them. PCEC advocates for projects that will explore the effectiveness of using specialist offices, including urology practices, as the central medical home or accountable care entity.
-PCEC supports the provisions for medical home and ACO pilots provided for within the Patient Protection and Affordable Care Act.
-PCEC supports adjustments to The Stark Law to eliminate incentives for urologists to provide radiation treatment without justification.
- Efforts to coordinate and integrate care between health providers and cancer patients, specifically, proposals that would call for cancer survivors to be provided with a treatment summary and follow-up plan upon completing cancer treatment, as well as programs to encourage interdisciplinary systems that provide integrated cancer care.
-PCEC encourages the adoption of Comprehensive Cancer Care Improvement Act S.1773/H.R.1844.
- Oversight agencies, including the Department of Health and Human Services, to incorporate prostate condition data collection points into EHR design and implementation. For example, EHRs can collect information on annual screening tests, screening test results, and changes in screening results. Additionally, PCEC supports efforts to guarantee patients the right to “own” their EHRs and to access and utilize the data at in the electronic record at their discretion.
Conclusion
PCEC is encouraged by the developments taking place within the care coordination landscape. We believe that implementation of care coordination, as discussed above, has the potential to make a considerable difference in the lives of men at risk for or living with various prostate conditions. We look forward to opportunities to support these important mechanisms as they are put into practice.
**************************
<!--EndFragment-->
Comparison of Percent-Free PSA, PSA Density, and Age-Specific PSA Cutoffs for Prostate Cancer Detection and Staging
W.J. Catalona; P.C. Southwick; K.M. Slawin; A.W. Partin; M.K. Brawer; R.C. Flanigan, et al. Urology, August 2000
This study concludes that the percent-free PSA test was either equal to or better than two other methods of detecting prostate cancer. Researchers examined three methods: age-specific PSA reference ranges, PSA density (PSAD), and percent-free PSA. Researchers found that the free PSA assay was significantly better than age-specific PSA reference ranges. Percent-free PSA and PSA density provided equally accurate results. This paper states the free PSA assay may be used in place of PSAD to determine whether a biopsy was necessary and to help make treatment decisions.
The Prostate Cancer Education Council's Article Series consists of articles written by a select panel of distinguished urologists from across the nation. Each article addresses a topic related to advancements in prostate cancer treatment, research, and prevention. Informative sidebars accompany each segment, along with highlighted technical vocabulary hyperlinked to a prostate cancer glossary, creating an easily digestible format for consumers.
The current article series includes:
Value of PSA and Free PSA Tests Validated in New Prostate Cancer Guidelines
Features William J. Catalona, M.D., professor at Washington University in St. Louis
PSA Test a Cause for Concern? Not So Fast
Features William J. Catalona, M.D., professor at Washington University in St. Louis
PSA: What's the Prognosis?
Features William J. Catalona, M.D., professor at Washington University in St. Louis
Evaluating PSA Levels in Men on Oral Medication to Treat Prostate Disease
Features William J. Catalona, M.D., professor at Washington University in St. Louis
5 in 5: Take Five Minutes for Five Questions about Prostate Cancer
Mark A. Moyad, MD, MPH ; Phil F Jenkins, Director of Complementary/Preventive Medicine
Selenium and Vitamin E Supplements for Prostate Cancer: Evidence or Embellishment?
Mark A. Moyad, MPH
The Role of Urodynamics in Assessing Symptomatic Benign Prostatic Hyperplasia
Ian K. Walsh, MD, FRCS; Anthony R. Stone, MD, FRCS
Immediate versus Delayed Therapy for Prostate Cancer: Earlier is Better
E. David Crawford, M.D.
Use of the LigaSure™ Vessel Sealing System in Urologic Cancer Surgery
E. David Crawford, MD; Jenifer S. Kennedy, PhD; Vonne Sieve
