Mp33-14 the Relationship Between Market Competition and Low-Value Prostate and Breast Cancer Screening

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety II (MP33)1 May 2024MP33-14 THE RELATIONSHIP BETWEEN MARKET COMPETITION AND LOW-VALUE PROSTATE AND BREAST CANCER SCREENING Nicole Murray, Joshua Horns, Jiaming Li, Jonathan Chipman, Hailie Gill, and Brock O'Neil Nicole MurrayNicole Murray , Joshua HornsJoshua Horns , Jiaming LiJiaming Li , Jonathan ChipmanJonathan Chipman , Hailie GillHailie Gill , and Brock O'NeilBrock O'Neil View All Author Informationhttps://doi.org/10.1097/01.JU.0001009520.30626.80.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Market competition of physicians has been shown to be related to prices and quality in health care. This study investigates the relationship of primary care provider competition to the receipt of low value PSA testing and mammography. METHODS: We conducted a retrospective cohort study using Medicare data. Low-value care was defined as PSA and mammograms ordered for men and women above the age of 75, without a history of prostate or breast cancer respectively. We identified internal medicine and family practice providers using Medicare claims and made note of whether LVC imaging was ordered for that patient within each calendar years. Patient-provider units were categorized into health service areas (HSA) based on the zip code of the physician. We then used National Provider Identifier files to calculate competition within each HSA. Competition was calculated using the Hirschman-Herfindahl Index (HHI), with low values representing competitive markets and high values representing concentrated markets. HHI was categorized into deciles and modeled as a factor. We then ran logistic regression models, modeling receipt of LVC against HHI. Separate models were also run for low-value PSA and mammogram. Patients' cancer risks were defined by the family history of prostate or breast cancer, depending on the model. RESULTS: Providers located in areas with higher market competition (low HHI) were found to deliver more LVC PSA testing. This rate decreased as the market competition concurrently decreased, with the exception of the lowest HHI decile. A relationship between market competition and LVC mammogram imaging was not observed. CONCLUSIONS: Primary care physicians are less likely to order low-value PSA testing in areas with lower healthcare competition. However, there does appear to be an exception in markets with the least competition, suggesting that there is an ideal market-competition level where LVC is least likely to be provided. That our analysis did not find a significant association between low-value mammography and market competition argues for further study to understand the complex relationship between healthcare competition and LVC. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e565 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Nicole Murray More articles by this author Joshua Horns More articles by this author Jiaming Li More articles by this author Jonathan Chipman More articles by this author Hailie Gill More articles by this author Brock O'Neil More articles by this author Expand All Advertisement PDF downloadLoading ...