MA plan design may steer patients to specific centers, researchers suggest
https://www.medpagetoday.com/publichealthpolicy/medicare/117949
Key Takeaways
- Enrollment in Medicare Advantage among those undergoing cancer surgeries increased from 32% in 2016 to 46% in 2022.
- Medicare Advantage enrollees were less likely to undergo cancer surgery at high-quality hospitals versus traditional Medicare beneficiaries.
- These findings suggest the Medicare Advantage plan design may steer patients to specific centers, potentially limiting choice.
Patients enrolled in Medicare Advantage (MA) plans were less likely to receive cancer surgery at high-quality hospitals compared with traditional Medicare enrollees, a national retrospective cohort study suggested.
Among over 500,000 older adults, higher proportions enrolled in traditional Medicare underwent cancer surgeries at high-quality hospitals compared with those in MA plans:
- Esophagectomy: 21.7% vs 17.3%
- Pancreatectomy: 22.6% vs 16.2%
- Hepatectomy: 22.1% vs 17.5%
- Gastrectomy: 23.4% vs 15.9%
- Cystectomy: 21.9% vs 17.1%
- Colectomy: 20.5% vs 19.5%
- Nephrectomy: 21.1% vs 18.4%
- Prostatectomy: 21.7% vs 17.7%
Moreover, MA beneficiaries were less likely than traditional Medicare beneficiaries to bypass a low-quality hospital in order to reach a high-quality center, reported Avinash Maganty, MD, MS, of Massachusetts General Hospital in Boston, and colleagues in JAMA Surgery
.
“This suggests that MA plan design may steer patients to specific centers and thereby potentially limit choice,” they wrote, which raises concerns “about the adequacy of cancer care delivery under privatized Medicare.”
Although there are “strong incentives” for MA plans to constrain utilization and to contain costs by avoiding contracts with high-quality centers that demand higher reimbursements, there are also incentives to ensure quality care, Maganty and team noted.
“However, the indicators they use to assess hospital quality may emphasize conditions more prevalent among their enrollees, rather than those specific to complex cancer care,” they added. “Notably, in our analysis, we found no association between MA plan star ratings, which are intended to reflect overall quality of a given contract, and the likelihood of receiving surgery at a high-quality hospital.”
In an accompanying
commentary, J. Joshua Smith, MD, PhD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues observed that while this study focused on procedure-specific mortality as a metric for the quality of cancer care, a broader definition of high-quality oncologic surgical care could include operative and pathologic standards, complication and readmission rates, patient experience ratings, and survival.
They suggested that a definition of cancer care quality should “extend beyond surgery, encompassing multiple oncologic disciplines, from diagnosis to palliative and end-of-life care.”
“Education about comprehensive cancer care quality would allow more informed insurance choices,” they concluded. “As healthcare policymakers develop a framework to improve care access, the surgical community must deliver the highest-quality surgical care regardless of the healthcare setting.”
For this study, Maganty and colleagues used Medicare Provider Analysis and Review data from January 2016 through November 2022. They included 567,770 Medicare beneficiaries who underwent elective surgery for esophageal, pancreatic, liver, gastric, bladder, colon, kidney, or prostate cancer at hospitals across the U.S. During the study period, enrollment in MA among those undergoing cancer surgeries increased from 32% to 46%.
Of the 351,447 enrolled in traditional Medicare, mean age was 72.5, 65.8% were men, 85.5% were white, and 9.1% were Black. Of the 216,323 enrolled in MA, mean age was 72.7, 64% were men, 78.8% were white, and 13.4% were Black.
Hospital quality was defined by procedure-specific mortality, risk-adjusted for patient characteristics and reliability-adjusted for differences in case volume using mixed-effects logistic regression models.
Compared with traditional Medicare beneficiaries, MA beneficiaries were more likely to have three or more comorbid conditions (47% vs 45%), more likely to reside in socially vulnerable areas (28.8% vs 24.6%), and less likely to undergo surgery at a teaching hospital (31% vs 36%).
MA beneficiaries traveled shorter distances to a treatment hospital for all procedures compared with traditional Medicare enrollees (mean 36 miles vs 60 miles). They lived closer to a high-quality hospital, but were less likely to bypass a lower-quality hospital to receive surgery at a high-quality hospital.
Filed under: General Problems
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