Introduction:

Within the United States, a shift in the organization of medical practice is ongoing. As independently owned groups merge and are acquired by larger hospitals systems, physicians are working in increasingly larger group practices and those employed by hospital systems. These changes have implications on the management of men with prostate cancer. Yet, the extent to which urology practices are changing is not well understood.

Methods:

Using Medicare claims data from the Medicare Data on Provider Practice and Specialty file, we identified all urologists billing Medicare and the practice with which they were affiliated from 2010 through 2016. Based on number and specialty of included physicians, we characterized groups as solo (1-2 urologist in practice of at least half urologists), small single specialty (3-9 urologists in practice of at least half urologists), large single specialty (10 or more physicians in practice with at least half urologists), specialist only (less than half urologists and no primary care physicians), and multispecialty groups (less than half urologists and at least one primary care physician). We identified hospital-owned groups as those that had at least a 3:1 ratio of services that were billed with a “hospital outpatient department” versus “office” place of service. Using a sample of national Medicare claims, we identified all patients with incident prostate cancer, as well as each patient’s urologist, treatment received, and total standardized Medicare spending within 1 year of diagnosis.

Results:

The number of urologists increased from 9,305 in 2010 to 9,570 in 2016, while the number of practices decreased from 3,588 to 2,861 in the same period. The proportion of urologists in a multispecialty group increased from 17.1% in 2010 to 28.2%% in 2016, while those within smaller groups declined (Figure 1). Hospital-owned groups included 4.6% of all urologists in 2010 but increased to include 7.9% of urologists by 2016. In each year, hospital-owned practices had the lowest mean spending per patient with incident prostate cancer, while large single specialty groups had the highest. Hospital-owned groups provided observation and surgery more often than other groups, while large single specialty groups used more radiation therapy than other group types.

Conclusion:

Urology group practice organization trends appear to be mirroring those of the medical profession as a whole. Increasingly, urologists are employed in multispecialty and hospital-owned groups. As previous studies have demonstrated there is an association between practice type and treatment decisions. It is important to understand this shift and its implications on the management of prostate cancer and other urologic disease.  

Funding: N/A