Payment Bundles for Prostatectomy: A New Way to Improve Value for Prostate Cancer Care.

Abstract

American healthcare expenditures exceed $4 trillion annually, with prostate cancer (PCa) accounting for $22 billion. Prostatectomy, a common treatment for PCa, incurs significant cost variability. Value-based care (VBC), emphasizing outcomes and efficiency over volume, has emerged as a potential solution. Bundled payment models, such as Medicare's Comprehensive Care for Joint Replacement (CJR), attempt to align financial incentives with quality but face challenges, including patient variability and misaligned incentives. Building on this, the Transforming Episode Accountability Model (TEAM) introduces longitudinal, episode-based bundles for five predefined surgeries. While urologic surgeries are currently excluded, the evolving landscape presents an opportunity to implement prostatectomy-specific bundles. Urology has piloted condition-specific bundles, such as Vanderbilt University's kidney stone bundle and the Large Urology Group Practice Association's (LUGPA) active surveillance (AS) bundle for PCa. These initiatives align incentives for comprehensive, guideline-based care but have yet to achieve widespread adoption. We propose a novel prostatectomy bundle that incentivizes urologists to optimize surgical outcomes, reduce complications, and enhance postoperative care. By incorporating disease-specific quality metrics and graded payments based on cancer severity, this model addresses critical barriers, including fair physician compensation and equity in access. Urology, uniquely positioned at the intersection of surgery and office-based care, can lead VBC innovation. TEAM's emphasis on care coordination, equity, and quality offers a promising foundation for refining bundles. With active physician involvement in VBC design, prostatectomy-specific bundles could advance cost, efficiency, and outcomes in PCa care.