{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T20:06:19Z","timestamp":1785182779087,"version":"3.55.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["5P01AG032952"],"award-info":[{"award-number":["5P01AG032952"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021671","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01 CA279746"],"award-info":[{"award-number":["R01 CA279746"]}],"id":[{"id":"10.13039\/501100021671","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 9124 urologists practicing in hospital referral regions (HRRs) with at least 1 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 (&amp;lt;30% of local urologists) or broad. Outcomes were weighted by network enrollment and included urologist characteristics, prostate cancer\u2013related and benign procedure volume, and 2 claims-based quality measures: use of magnetic resonance imaging (MRI) prior to prostate biopsy and consultation with radiation oncology after new prostate cancer diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 9124 urologists, 98% participated in at least 1 MA network. Across 7516 network\u2013HRR combinations, networks included a mean (SD) of 42 (47) urologists, 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 &amp;lt; .01), performed more prostate biopsies (3.18 vs 2.89 per year; P &amp;lt; .01), and performed more prostatectomies (0.48 vs 0.35 per year; P &amp;lt; .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 &amp;lt; .01). Quality patterns were mixed, with higher MRI use prior to biopsy (15% vs 12%; P &amp;lt; .01) but lower radiation oncology consultation (50% vs 54%; P &amp;lt; .01). Among 12, 735 network\u2013county combinations, 1.8% failed to meet Medicare's urologist adequacy standards.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxag172","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:20:31Z","timestamp":1783084831000},"source":"Crossref","is-referenced-by-count":0,"title":["Characteristics of urologists participating in Medicare Advantage networks and implications for prostate cancer care"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6436-6667","authenticated-orcid":false,"given":"Avinash","family":"Maganty","sequence":"first","affiliation":[{"name":"Department of Urology, Massachusetts General Hospital , Boston, MA 02114 ,","place":["United States"]},{"name":"Department of Surgery, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9047-7731","authenticated-orcid":false,"given":"Eran","family":"Politzer","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]},{"name":"Federmann School of Public Policy and Governance, The Hebrew University of Jerusalem , Jerusalem 91905 ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4569-3838","authenticated-orcid":false,"given":"Asa","family":"Hartman","sequence":"additional","affiliation":[{"name":"Federmann School of Public Policy and Governance, The Hebrew University of Jerusalem , Jerusalem 91905 ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4840-1260","authenticated-orcid":false,"given":"Brent K","family":"Hollenbeck","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan , Ann Arbor, MI 48109 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4912-0647","authenticated-orcid":false,"given":"Bruce","family":"Landon","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of General Medicine, Beth Israel Deaconess Medical Center , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"2026072715385732000_qxag172-B1","author":"Freed"},{"issue":"4","key":"2026072715385732000_qxag172-B2","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1111\/1475-6773.13970","article-title":"Implementation of resource use measures in Medicare Advantage","volume":"57","author":"Jung","year":"2022","journal-title":"Health Serv Res"},{"key":"2026072715385732000_qxag172-B3","author":"Jacobson"},{"issue":"4","key":"2026072715385732000_qxag172-B4","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14308","article-title":"Restrictiveness of Medicare Advantage provider networks across physician specialties","volume":"59","author":"Feyman","year":"2024","journal-title":"Health Serv Res"},{"issue":"3","key":"2026072715385732000_qxag172-B5","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1377\/hlthaff.2023.00803","article-title":"Primary care physicians in Medicare Advantage were less costly, provided similar quality versus regional average","volume":"43","author":"Politzer","year":"2024","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"2026072715385732000_qxag172-B6","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1377\/hlthaff.2017.0714","article-title":"Medicare Advantage enrollees more likely to enter lower-quality nursing homes compared to fee-for-service enrollees","volume":"37","author":"Meyers","year":"2018","journal-title":"Health Aff (Millwood)"},{"key":"2026072715385732000_qxag172-B7","author":"American Cancer Society"},{"issue":"4","key":"2026072715385732000_qxag172-B8","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1016\/j.juro.2018.01.002","article-title":"Clinically localized prostate cancer: AUA\/ASTRO\/SUO guideline. 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