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Exploring Accountable Care Organizations’ impact on cancer screenings

May 29, 2015 | Josh Brown

As health care organizations implement new strategies to improve quality and reduce costs, a physician researcher at VUMC is setting out to identify whether there could be unintended effects.

Matthew Resnick, M.D., MPH, assistant professor of Urologic Surgery and Health Policy, has been awarded a $726,000 grant from the American Cancer Society to study the impact of Accountable Care Organizations (ACO) on the appropriateness of cancer screenings.

ACOs are groups of care providers that participate in a Medicare incentive program aimed at controlling growth in health care costs while improving health care quality. The program was part of the Affordable Care Act.

Matthew Resnick, M.D., MPH

Matthew Resnick, M.D., MPH

The Cancer Society’s Mentored Research Scholar Grant in Applied and Clinical Research will provide Resnick funding for five years to study patients undergoing screenings for breast cancer, colorectal cancer and prostate cancer to try to identify both the positive and negative effects of changes in screening attributed to ACO enrollment.

“We know from previously published data that for patients in the ACOs, the rates of cancer screenings increased,” Resnick said. “What’s unknown is whether the observed increase in screening has taken place in appropriate patients.”

Physicians have identified certain age groups of patients that seem to benefit less from regular cancer screenings, Resnick said.

Screening rates for breast and colorectal cancers are included as positive quality measures in the Medicare Shared Savings Program, rewarding organizations with high screening rates, but without direct penalty for organizations engaged in over-screening.

“Is there a downside to these quality measurement strategies?” Resnick said. “One of the principal goals of this investigation is to identify potential unintended consequences of payment reform and to identify strategies to mitigate them.”

Melinda Buntin, Ph.D., chair of Department of Health Policy, said Resnick’s study comes at a key time.

“Within the past month key studies have been published about the overall cost savings achieved by ACOs, but we still know little about how preventive care, and care for specific conditions — like cancer — is affected,” Buntin said. “The ACO model is centered around primary care providers. The role of specialists within these organizations needs to be better understood.”

David Penson, M.D., chair of Vanderbilt’s Department of Urologic Surgery, called the research project “groundbreaking.”

“It’s critically important that we learn what the impact of alternative payment models have on cancer care,” said Penson, the Paul V. Hamilton, M.D., and Virginia E. Howd Professor of Urologic Oncology and a professor of Urologic Surgery, Medicine and Health Policy. “This isn’t important just to Vanderbilt. It’s crucial information that will inform national healthcare policy going forward.”

Penson said Resnick was well suited to take on the task.

“I’m not surprised that the American Cancer Society gave Matt one of these prestigious awards,” Penson said. “He is truly a unique individual, a surgeon-scientist who is doing incredibly relevant policy work. There are only a handful of researchers like Matt in the United States, and we’re lucky to have him here at Vanderbilt.”