{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T08:06:32Z","timestamp":1753862792750,"version":"3.41.2"},"reference-count":45,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T00:00:00Z","timestamp":1742428800000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01 CA269367","R01 CA279746","T32 CA180984"],"award-info":[{"award-number":["R01 CA269367","R01 CA279746","T32 CA180984"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Medicare Advantage (MA) managed care plans, now chosen by 51% of Medicare beneficiaries, are incentivized to constrain healthcare spending and utilization, a shift in financial incentives compared to Traditional Medicare's fee\u2010for\u2010service payment model. Beyond its primary beneficiaries, MA's mechanisms to constrain utilization may impact Traditional Medicare beneficiaries with prostate cancer through \u201cspillover\u201d effects on physician behavior.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From a 20% sample of Medicare claims, we identified patients diagnosed with prostate cancer from 2016 to 2019. We calculated MA penetration [MA beneficiaries\/(Traditional Medicare and MA beneficiaries)] at the practice\u2010level. We assessed the relationship between practice\u2010level MA penetration and two measures of quality\u2014potential overtreatment (i.e., treatment among those with &gt;\u200975% noncancer mortality within 10\u2009years of diagnosis) and confirmatory testing (repeat prostate biopsy, MRI, or genomic test)\u2014using a multilevel logistic regression. We also assessed two measures of utilization, price standardized spending (i.e., global utilization) and overall treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 41,092 patients. Median practice\u2010level MA penetration was 33% (IQR 23%\u201343%). Increasing practice\u2010level MA penetration was associated with increased odds of overall treatment among all Traditional Medicare beneficiaries (adjusted OR 1.03 (95% CI 1.01\u20131.05), <jats:italic>p<\/jats:italic>\u2009=\u20090.01, per 10% increase in MA penetration). However, MA penetration was not associated with our quality measures, potential overtreatment and confirmatory testing, or price\u2010standardized spending.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>MA penetration at the urology practice\u2010level varies considerably. In men with prostate cancer, greater practice\u2010level MA penetration was associated with increased odds of treatment, but not overall utilization\u2014even where it might influence quality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.70796","type":"journal-article","created":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T04:15:58Z","timestamp":1742703358000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spillover Effects of Medicare Advantage on Traditional Medicare Beneficiaries With Prostate Cancer"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9772-1415","authenticated-orcid":false,"given":"Arnav","family":"Srivastava","sequence":"first","affiliation":[{"name":"Dow Division of Health Services Research, Department of Urology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel R.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Dow Division of Health Services Research, Department of Urology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Urology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avinash","family":"Maganty","sequence":"additional","affiliation":[{"name":"Department of Urology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1651-317X","authenticated-orcid":false,"given":"Addison","family":"Shay","sequence":"additional","affiliation":[{"name":"Dow Division of Health Services Research, Department of Urology University of Michigan  Ann Arbor Michigan 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