Patients with cancer may face differences in outcome depending on risk adjustment based on Medicare administrative data at the hospital level, according to a recent study published online ahead of print in JAMA Oncology.

David Pfister, MD, of the Memorial Sloan Kettering Cancer Center in New York, NY, looked at risk-adjusted cumulative mortality rates of 729,279 patients with cancer through Medicare data from 2005 to 2009 in order to evaluate the performance of hospitals that treat these patients for outcomes and risk adjustment. An additional 18,677 patients were included from SEER-Medicare administrative data.

Types of cancer included prostate, breast, and colon, and hospitals that treated 10 or more of these kinds of patients were included.

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The researchers found large survival differences between different types of hospitals, with mortality for patients treated by hospitals exempt from Medicare prospective payment system being 10% lower than at community hospitals for all cancers at 1-year. The same pattern was found through 5 years of follow-up and within specific cancer categories.

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Additionally, performance ranking of hospitals was found to be consistent with or without SEER-Medicare disease stage information.

“This type of risk adjustment may be adequate for evaluating hospital performance, since the additional adjustment for data available only in cancer registries does not seem to appreciably alter measures of performance,” the authors concluded.


  1. Pfister DG, Rubin DM, Elkin EB, et al. Risk adjusting survival outcomes in hospitals that treat patients with cancer without information on cancer stage. [published online ahead of print October 8, 2015]. JAMA Oncol. doi:10.1001/jamaoncol.2015.3151.