August 17, 2021
3 min read
Takvorian reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Keating reports no relevant financial disclosures.
Insurers of patients with private insurance who underwent cancer surgery spent more per surgical episode at NCI centers than at community hospitals, according to study results published in JAMA Network Open.
Researchers observed the cost disparity despite no differences in care utilization.
“Amid a backdrop of relentlessly rising cancer care expenditures nationally, it is critical that our system delivers high-value cancer care – ie, care of the highest possible quality at the lowest possible cost,” Samuel U. Takvorian, MD, MSHP, assistant professor in the division of hematology and oncology at Perelman School of Medicine at University of Pennsylvania, told Healio. “Our work sought to illuminate prices paid and spending incurred for surgical episodes across different types of hospitals, which is necessary to begin to understand value trade-offs across sites of care.”
Samuel U. Takvorian
The cross-sectional, retrospective study included 66,878 adults (77.1% women; 47.2% aged 65 years) with incident breast (53.5%), colon (32%) or lung (14.5%) cancer. Study participants underwent surgery between 2011 and 2014 at 2,995 hospitals (8.3% at NCI centers, 16.3% at non-NCI academic hospitals and 75.4% at community hospitals).
Takvorian and colleagues used validated, claims-based algorithms — adapted for use in private as opposed to Medicare claims — to identify incident cancer cases and cancer-directed surgical procedures that met their specifications, they wrote.
They examined mean risk-adjusted spending and utilization outcomes for each type of hospital using multilevel generalized linear mixed-effects models, which they adjusted for hospital, region and patient characteristics.
The Health Care Cost Institute’s national multipayer commercial claims data set, from which researchers gathered payment data, included claims paid by three of the nation’s biggest commercial health insurers: Aetna, Humana and UnitedHealthcare.
Surgery-specific insurer prices paid and 90-day post-discharge payments served as the primary spending outcomes. Hospital length of stay, ED use, and hospital readmission within 90 days of discharge served as the primary utilization outcomes.
Results showed an association of treatment at NCI centers with higher surgery-specific insurer prices paid (mean, $18,526; 95% CI, 16,650-20,403) compared with community hospitals (mean, $14,772; 95% CI, 14,339-15,204), a difference of $3,755 (95% CI, 1,661-5,849).
Treatment at NCI centers vs. community hospitals also appeared associated with higher 90-day post-discharge payments (mean, $47,035; 95% CI, 43,289-50,781 vs. $41,291; 95% CI, 40,350-42,231), for a difference of $5,744 (95% CI, 1,659-9,829).
“We were surprised by the magnitude of spending and spending differences across sites of care. These differences were not explained by observable differences in case mix,” Takvorian said.
The researchers found no significant differences between length of stay, ED use, or hospital readmission within 90 days of discharge.
Takvorian and colleagues concluded that a better understanding of factors associated with prices and spending at NCI centers is needed.
“Our study did not evaluate the degree to which patients were exposed to the higher costs of NCI centers and/or academic centers,” Takvorian said. “Future studies should address this important dimension of financial burden.”
Additional research is needed to improve understanding of prices and “reliably measure the quality of care delivered to patients with cancer across hospitals and practices,” Nancy L. Keating, MD, MPH, professor in the department of health care policy at Harvard Medical School and professor of medicine and practicing general internist at Brigham and Women’s Hospital, wrote in an accompanying editorial.
“Such information is critical to assess the extent to which payers and patients achieve value for health care dollars spent at NCI-designated cancer centers and to identify subgroups of patients for whom highly specialized care is particularly necessary to achieve better outcomes,” Keating wrote.
For more information:
Samuel U. Takvorian, MD, MSHP, can be reached at Division of Hematology and Oncology, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd., 10 South, Philadelphia, PA 19104; email: [email protected]