Characteristics of Urologists Participating in Medicare Advantage Networks and Implications for Prostate Cancer Care

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Abstract
Background: Enrollment in Medicare Advantage (MA) has expanded rapidly and MA plans may rely on selective provider networks to manage utilization. While selective contracting has been described for primary care physicians, less is known about how MA networks are constructed for surgical specialists such as urologists, who manage common and costly conditions including prostate cancer. Methods: We conducted a national observational study using a 20% sample of Medicare fee-for-service claims (2016 to 2021) linked to 2021 MA network data. We identified 9,124 urologists practicing in hospital referral regions (HRR) with at least one MA network. Urologists were classified as in-network or out-of-network within each network-HRR and further categorized by network breadth, defined as narrow (<30% of local urologists) or broad. Outcomes were weighted by network enrollment and included urologist characteristics, prostate cancer-related and benign procedure volume, and two claims-based quality measures: use of MRI prior to prostate biopsy and consultation with radiation oncology after new prostate cancer diagnosis. Results: Among 9,124 urologists, 98% participated in at least one MA network. Across 7,516 network-HRR combinations, networks included a mean of 42 urologists (SD 47), with inclusion ranging from 9% to 100% of local urologists. Compared with the average urologist excluded from a network in the HRR, the average in-network urologist had a higher annual patient volume (107 vs 95, p<0.01), performed more prostate biopsies (3.18 vs. 2.89 per year, p<0.01), and performed more prostatectomies (0.48 vs. 0.35 per year, p<0.01), without differences in quality measures. The average urologist in narrow networks had a lower overall procedure volume but were more likely to perform prostatectomy among newly diagnosed patients (21% vs. 14%, p<0.01). Quality patterns were mixed, with higher MRI use prior to biopsy (15% vs. 12%, p<0.01) but lower radiation oncology consultation (50% vs. 54%, p<0.01). Among 12,735 network-county combinations, 1.8% failed to meet Medicare’s urologist adequacy standards. Conclusions: MA urology networks vary widely in breadth and composition. Narrow networks are associated with distinct prostate cancer management patterns that may have implications for access and quality, underscoring the need to assess specialty network adequacy standards.
Funding Information
  • National Institute on Aging (5P01AG032952)
  • Instituto Nacional do Câncer, Ministério da Saúde (R01 CA279746)

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