Medicare’s cost-saving advantage may be a disadvantage for patients with complex cancer surgery

An analysis by researchers at City of Hope, one of the largest cancer research and treatment organizations in the United States, found that cancer patients who enjoyed a privatized Medicare Advantage and cost saver were more likely than those with traditional Medicare to go to hospitals with fewer doctors. experienced in performing complex surgeries, and were more likely to die within the first 30 days after removal of the stomach, pancreas, or liver. the studyMedicare advantage: a disadvantage for complex cancer surgery patientsIt was recently published in Journal of Clinical Oncology.

The result is significant because nearly half of Medicare beneficiaries – ; An estimated 29 million Americans – ; Are enrolled in Medicare Advantage plans. Of the 6.6 million Californians eligible for Medicare, nearly half (47%) are enrolled in Medicare Advantage plans.

With traditional Medicare, beneficiaries may typically go to any doctor or hospital in the United States that takes Medicare, while in most cases, Medicare Advantage beneficiaries can only see doctors and providers who are in the plan’s network and service area.

The study suggests that cancer patients who use Medicare Advantage would experience better short-term health outcomes if more of them had access to hospitals that often perform complex cancer surgeries. Research has frequently associated improved surgical outcomes with cancer patients who receive care at a National Cancer Institute-designated cancer center, such as City of Hope, or at hospitals with large surgery volumes or approved by the Cancer Committee.”

Mostafa Raouf, MD, MA, a surgical oncologist at City of Hope and lead author of the new study

The City of Hope is a federally recognized comprehensive cancer center known for its cutting-edge research focused on developing new and better approaches to cancer prevention, diagnosis and treatment.

said Joseph Alvarnas, vice president of government affairs at City of Hope, who was not involved in the study.

In the retrospective study, City of Hope researchers analyzed California Cancer Registry data from 76,655 Medicare beneficiaries who had surgery for cancer of the lung, esophagus, stomach, pancreas, liver, colon, or rectum. They found that cancer patients who had their stomach or liver removed and got Medicare Advantage were 1.5 times more likely to die within the first month after surgery than their peers who were treated with traditional Medicare. Similarly, the study showed that Medicare Advantage beneficiaries who had pancreatic tumor surgery were twice as likely to die within the first month.

People with traditional Medicare were more likely to be treated at a teaching hospital (23% vs. 8%), a cancer committee-approved hospital (57% vs. 33%) or a National Cancer Institute-designated cancer center (15% vs. 3%). ). Recipients of conventional medical care were more likely to be treated in hospitals with a higher median number of total beds, intensive care beds, operating rooms and annual inpatient surgery volume.

On the other hand, Medicare Advantage beneficiaries experienced a delay of more than two weeks from diagnosis to the first course of treatment. The reason for the delay may be the required prior authorization that Medicare Advantage beneficiaries with the HMO must undergo. While this referral process is intended to reduce unnecessary medical care, it can cause delays for Medicare Advantage beneficiaries who need specialized services, such as complex cancer surgery.

“The study data can inform policymakers and insurers who want to extend the lives of cancer patients,” Raouf said.

Alvarnas added, “As of the end of the current enrollment period, it is likely that 50% of Medicare beneficiaries will be enrolling in Medicare Advantage plans. And while those plans can provide patients with some additional benefits, there is a significant missed opportunity in the tight network design that many are doing.” of these plans are being used. Access to highly experienced cancer care, including surgical care, leads to better patient outcomes.”


Journal reference:

Raouf, M.; et al. (2022) The Medicare Advantage: A Disadvantage for Complex Cancer Surgery Patients. Journal of Clinical Oncology.

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