TOPLINE:

In a national study of Medicare beneficiaries undergoing cancer surgery, those enrolled in a Medicare Advantage plan were less likely to receive care at a high-quality hospital or to bypass nearer, lower-quality hospitals.

METHODOLOGY:

• More than half of Medicare beneficiaries are enrolled in privatized Medicare Advantage plans, which may limit access to regional cancer centers. But it is unclear whether enrollees are less likely to undergo cancer surgery at top-performing hospitals.
• Using a national claims database, researchers analyzed data from 567,770 Medicare beneficiaries who underwent elective surgery for esophageal, pancreatic, liver, gastric, bladder, colon, kidney, or prostate cancer between January 2016 and November 2022. Of these, 351,447 were traditional Medicare beneficiaries (65.8% male; mean age, 72.5 years), and 216,323 were Medicare Advantage enrollees (64% male; mean age, 72.7 years).
• Hospitals were ranked by 30-day procedure-specific mortality, adjusted for factors such as hospital case mix and case volumes, and divided into quintiles. Those in the lowest mortality quintile were classified as high-quality hospitals.
• The primary outcome was receipt of surgery at a high-quality hospital, with adjustment for patient demographic characteristics and comorbidities. The secondary outcome was the likelihood of bypass — defined as traveling to a high-quality center when the nearest hospital that performs the needed surgery is of lower quality.

TAKEAWAY:

• Those in Medicare Advantage plans had a lower probability of undergoing surgery at high-quality hospitals than traditional Medicare beneficiaries, with the greatest differences seen in esophagectomy (21.7% vs 17.3%), pancreatectomy (22.6% vs 16.2%), gastrectomy (23.4% vs 15.9%), and hepatectomy (22.1% vs 17.5%).
• Medicare Advantage beneficiaries traveled shorter distances to their treatment center than traditional Medicare beneficiaries (mean, 36 miles vs 60 miles), with the longest travel for pancreatectomy (58 miles vs 98 miles) and the shortest travel for colectomy (28 miles for both groups).
• On average, Medicare Advantage beneficiaries lived closer to high-quality hospitals than traditional Medicare beneficiaries, but they were less likely to bypass lower-quality hospitals to receive surgery at a high-quality center. This pattern was seen across procedures but was most evident for gastrectomy, pancreatectomy, esophagectomy, and hepatectomy.
• Medicare Advantage plan star ratings did not show a consistent association with receipt of surgery at high-quality hospitals.

IN PRACTICE:

The findings suggest that Medicare Advantage networks “may limit access to optimal surgical care, raising concerns about the adequacy of cancer care delivery under privatized Medicare,” the authors of the study concluded. An invited commentary published with the study concurred. “This study reinforces concerns that [Medicare Advantage] may contribute to disparities in cancer care access,” wrote the authors of the study, led by Norman J. Galbraith, MBChB, PhD, of the University of Glasgow, Glasgow, Scotland. “Taken together, this growing body of evidence should encourage careful oversight of Medicare Advantage by the Centers for Medicare & Medicaid Services and inform future legislative improvements.”

SOURCE:

The study, led by Avinash Maganty, MD, MS, of Massachusetts General Hospital in Boston, was published online in JAMA Surgery.

LIMITATIONS:

The administrative claims database lacked detailed oncologic staging and other clinical factors that could have influenced the choice of hospital. In addition, the database captured approximately 90% of Medicare Advantage hospitalizations and potentially underrepresented some hospital admissions, particularly in rural areas. The study was subject to potential unmeasured confounding influencing both enrollment choice and treatment location.

DISCLOSURES:

This study was funded by the National Cancer Institute. Some authors reported receiving grants from the National Institutes of Health, the National Cancer Institute, the National Institute on Aging, and the Agency for Healthcare Research and Quality. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.