An evaluation by researchers at City of Hope, one among the most important cancer research and treatment organizations in the US, found that cancer patients with privatized, cost-saving Medicare Advantage were more likely than those with traditional Medicare to go to hospitals with physicians less experienced at performing complicated surgeries, and that they were more prone to die inside the first 30 days after the removal of their stomach, pancreas or liver. The study “Medicare Advantage: A Drawback for Complex Cancer Surgery Patients” was recently published within the Journal of Clinical Oncology.

The finding is essential because nearly half of all Medicare beneficiaries -; an estimated 29 million Americans -; are enrolled in Medicare Advantage plans. And of the 6.6 million Medicare-eligible Californians, nearly half (47%) are enrolled in Medicare Advantage plans.

With traditional Medicare, beneficiaries typically may go to any doctor or hospital within the U.S. that takes Medicare, whereas generally, Medicare Advantage beneficiaries can see only doctors and providers who’re within the plan’s network and repair area.

The study suggests that cancer patients with Medicare Advantage would experience higher short-term health outcomes if more of them had access to hospitals that continuously perform complex cancer surgery. Research has repeatedly linked improved surgical outcomes to cancer patients who receive care at a National Cancer Institute-designated cancer center, corresponding to City of Hope, or at hospitals with high surgery volumes or which can be accredited by the Commission on Cancer.”

Mustafa Raoof, M.D., M.S., surgical oncologist at City of Hope and lead creator of the brand new study

City of Hope is a federally recognized comprehensive cancer center known for its state-of-the-art research focused on developing latest and higher approaches to stopping, diagnosing and treating cancer.

“Dr. Raoof and colleagues’ study shows that far too many Medicare Advantage beneficiaries lack access to optimal cancer care and suffer opposed outcomes in consequence,” said Joseph Alvarnas, M.D., vice chairman for presidency affairs at City of Hope, who was not involved within the study.

Within the retrospective study, City of Hope researchers analyzed California Cancer Registry data from 76,655 Medicare beneficiaries who underwent elective inpatient cancer surgery of the lung, esophagus, stomach, pancreas, liver, colon or rectum. They found that cancer patients who had their stomach or liver removed and had Medicare Advantage were 1.5 times more prone to die inside the first month after surgery in comparison with their peers with traditional Medicare. Similarly, Medicare Advantage beneficiaries who had oncologic surgery of the pancreas were twice as prone to die inside the first month, the study showed.

Individuals with traditional Medicare were more prone to be treated at a teaching hospital (23% vs. 8%), hospital accredited by the Commission on Cancer (57% vs. 33%) or National Cancer Institute-designated cancer center (15% vs. 3%). Traditional Medicare beneficiaries were also more prone to be treated at hospitals with the next median variety of total beds, ICU beds, operating rooms and annual inpatient surgical volume.

Medicare Advantage beneficiaries, then again, experienced a delay of greater than two weeks from diagnosis to first course of therapy. A reason for the delay may very well be the required prior authorization that Medicare Advantage beneficiaries with an HMO should undergo. While this referral process is meant to limit unnecessary medical care, it may cause delays for Medicare Advantage beneficiaries who need specialized services, corresponding to complex cancer surgery.

“The study data can inform policymakers and insurers who need to extend the lifespan of cancer patients,” Raoof said.

Alvarnas added, “As of end of this current enrollment period, 50% of Medicare beneficiaries will likely enroll in Medicare Advantage plans. While these plans can provide patients with some added advantages, a big missed opportunity exists within the narrow network design that a lot of these plans utilize. Access to high expertise cancer care, including surgical care, produces higher outcomes for patients.”

Source:

Journal reference:

Raoof, M., et al. (2022) Medicare advantage: An obstacle for complex cancer surgery patients. Journal of Clinical Oncology. doi.org/10.1200/JCO.21.01359.