MA Beneficiaries May Be at Disadvantage for Complex Cancer Surgeries

Patients with cancer enrolled in Medicare Advantage (MA) are more likely to go to hospitals with physicians less experienced at performing complicated surgeries compared with patients with cancer enrolled in traditional Medicare, according to an analysis by researchers at City of Hope.

They also found these patients were more likely to die within 30 days after removal of their liver, pancreas, or stomach.

These findings were included in the study “Medicare Advantage: A Disadvantage for Complex Cancer Surgery Patients,” published in the Journal of Clinical Oncology.

To come to these findings, the study authors looked at the data of 76,655 Medicare beneficiaries. The median age was 74 and was made up of 51% women and 39% MA beneficiaries.

Their analysis included 31,913 colectomies, 10,358 proctectomies, 4604 hepatectomies, 2895 pancreatectomies, 3639 gastrectomies, 1555 esophagectomies, and 21,691 lung resections.

The authors found that beneficiaries were less likely to receive care at a high-volume hospital, except when undergoing colectomies.

Compared with traditional Medicare beneficiaries, mortality was significantly higher among MA beneficiaries undergoing:

• gastrectomy (adjusted risk difference [ARD], 1.5%; 95% CI, 0.01-2.9; P = .036)
• pancreatectomy (ARD, 2.0%; 95% CI, 0.80-3.3; P = .002)
• hepatectomy (ARD, 1.4%; 95% CI, 0.1-2.9; P = .04)

Patients with cancer enrolled in MA were 1.5 times more likely to die within 1 month after surgical removal of their stomach or liver, and twice as likely to die within 1 month after oncologic surgery of the pancreas, compared with patients with traditional Medicare.

However, the authors also found MA beneficiaries incurred lower estimated hospital costs compared with traditional Medicare beneficiaries.

Of an estimated 29 million Americans enrolled in Medicare, nearly half are enrolled in MA plans. Additionally, of the 6.6 million Medicare-eligible Californians, 47% are enrolled in MA plans.

A main difference is patients enrolled in Medicare can visit any doctor or hospital in the United States that accepts Medicare. However, in most cases, MA beneficiaries can only visit doctors and providers in the plan’s network and service area.

According to Joseph Alvarnas, MD, vice president for government affairs at City of Hope, this study—which he was not involved in—shows too many Medicare Advantage beneficiaries lack access to optimal cancer care and therefore suffer adverse outcomes.

“As of end of this current enrollment period, 50% of Medicare beneficiaries will likely enroll in Medicare Advantage plans,” he said in a statement from the City of Hope. “While these plans can provide patients with some added benefits, a significant missed opportunity exists in the narrow network design that many of these plans utilize. Access to high expertise cancer care, including surgical care, produces better outcomes for patients.”

The current Medicare open enrollment period ends December 7.

“The study suggests that cancer patients with Medicare Advantage would experience better short-term health outcomes if more of them had access to hospitals that frequently perform complex cancer surgery,” said Mustafa Raoof, MD, MS, surgical oncologist at City of Hope and lead author of the study. “Research has repeatedly linked improved surgical outcomes to cancer patients who receive care at a National Cancer Institute-designated cancer center, such as City of Hope, or at hospitals with high surgery volumes or that are accredited by the Commission on Cancer.”

Patients with traditional Medicare compared with MA were more likely to be treated at a teaching hospital (23% vs 8%), a hospital accredited by the Commission on Cancer (57% vs 33%), or a National Cancer Institute-designated cancer center (15% vs 3%).

Further, Medicare beneficiaries were more likely to be treated at hospitals with a higher median number of total beds, intensive care unit beds, operating rooms, and annual inpatient surgical volume.

However, MA beneficiaries experienced delays of more than 2 weeks from diagnosis to first course of therapy.

“A reason for the delay could be the required prior authorization that Medicare Advantage beneficiaries with an HMO have to undergo,” City of Hope said. “While this referral process is intended to limit unnecessary medical care, it can cause delays for Medicare Advantage beneficiaries who need specialized services, such as complex cancer surgery.”

Reference

Raoof M, Ituarte PHG, Haye S, et al. Medicare Advantage: a disadvantage for complex cancer surgery patients. J Clin Oncol. Published online November 10, 2022. doi:10.1200/JCO.21.01359