Patients with Medicare Advantage insurance plans have an increased risk of death after certain cancer surgeries, when compared with beneficiaries of traditional Medicare plans, according to research published in the Journal of Clinical Oncology.

Researchers found that patients with Medicare Advantage were more likely to be treated in low-volume hospitals and tended to have lower hospital costs. These patients also had an increased risk of death at 30 days after gastrectomy, pancreatectomy, and hepatectomy. 

This study included 76,655 Medicare beneficiaries who underwent complex cancer surgeries in California during 2000-2020. The cohort included 46,494 patients with traditional coverage and 30,161 with Medicare Advantage. 


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In both cohorts, the median age was 74 years, and 51% of patients were women. The median socioeconomic score for both groups was 3, with a range of 2-5 for those in the traditional Medicare group and 2-4 for those in the Medicare Advantage group. 

The surgeries performed (in the traditional and Medicare Advantage groups, respectively) were: 

  • Colectomy (39% and 45%)
  • Lung resection (29% and 27%)
  • Proctectomy (14% for both)
  • Hepatectomy (7% and 5%)
  • Gastrectomy (5% and 4%)
  • Pancreatectomy (4% for both)
  • Esophagectomy (2% for both). 

Medicare Advantage beneficiaries were significantly less likely to undergo surgery at a high-volume hospital compared with traditional beneficiaries, as indicated by a lower median number of beds (286 vs 374; P <.001), intensive care unit beds (24 vs 28; P <.001), annual inpatient surgical volume (3690 vs 4376; P <.001), and number of operating rooms (14 vs 18; P <.001). 

Medicare Advantage beneficiaries were also less likely to be cared for at a National Cancer Institute-designated cancer center (3% vs 15%; P <.001) or a Commission on Cancer-accredited hospital (33% vs 57%; P <.001).

Medicare Advantage beneficiaries had a significantly higher risk of death at 30 days after the following surgeries:

  • Gastrectomy (adjusted risk ratio [ARR], 1.40; 95% CI, 1.02-1.97; P =.036)
  • Pancreatectomy (ARR, 1.90; 95% CI, 1.30-2.77; P =.002)
  • Hepatectomy (ARR, 1.44; 95% CI, 1.01-2.05; P =.04). 

There were no significant differences between the Medicare Advantage and traditional Medicare groups for 30-day mortality risk after other surgeries.

The researchers also found that Medicare Advantage beneficiaries had lower estimated hospital costs for both index hospitalizations and 90-day hospitalizations for all surgeries studied (all P <.05). 

“Although MA [Medicare Advantage] beneficiaries incur less hospital costs, limited access to high-volume hospitals for liver, stomach, and pancreas operations may explain significantly worse postoperative outcomes after adjusting for covariates,” the researchers concluded.

“Efforts to control spiraling health care costs need to consider the impact on quality of care and patient outcome to avoid further widening health care disparities,” Kathy Miller, MD, senior deputy editor of the Journal of Clinical Oncology, wrote in a comment. 

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

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