1. DiGiulio, Sarah

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Medicare Advantage plans boast some attractive features compared with traditional Medicare plans. Some cover dental and vision care, and some offer gym membership options. And while what you pay and how you pay differs (e.g., up front in premiums versus meeting a deductible as you seek care), both claim to provide coverage for hospital stays and appointments with your doctors. Recent work, however, dug deeper to compare cancer surgery outcomes for patients on both plans (J Clin Oncol 2022; doi: 10.1200/JCO.21.01359). The research analyzed outcomes for 76,655 Medicare beneficiaries. Median age was 74 years. Fifty-one percent were female and 39 percent were on Medicare Advantage plans. The outcomes were those of 31,913 colectomies, 10,358 proctectomies, 4,604 hepatectomies, 2,895 pancreatectomies, 3,639 gastrectomies, 1,555 esophagectomies, and 21,691 lung resections. The data showed that enrollment in a Medicare Advantage plan is associated with lower estimated hospital costs, but also lower access to high-volume hospitals and increased 30-day mortality for stomach, pancreas, or liver surgery compared with traditional Medicare.

Mustafa Raoof, MD. M... - Click to enlarge in new windowMustafa Raoof, MD. Mustafa Raoof, MD

"To save cost, Medicare Advantage plans will restrict coverage to certain in-network hospitals and providers," noted Mustafa Raoof, MD, the study's lead author as well as Surgical Oncologist and Assistant Professor at City of Hope. "Whether cancer surgery quality was a priority when designing Medicare Advantage networks was an open question. We felt that it was likely not. That is indeed what we found." Here's what else Raoof said about the work.


1 Why did you and your colleagues decide to do this research now?

"We conducted this research now because Medicare Advantage plans have become increasingly popular. They are cost-effective, but the quality of health care across a spectrum of Medicare Advantage plans remains to be established. Specifically, nothing was known about the quality of cancer surgery in Medicare Advantage plans. We thought that these data could inform policy that ensures adequate quality of Medicare Advantage plans with respect to cancer surgery."


2 What were the key findings from your research and how do they compare with what was previously known about outcomes for cancer patients enrolled in Medicare Advantage versus traditional Medicare?

"When it comes to patients needing complex cancer surgery, Medicare Advantage plans save cost, but this comes at a hidden cost of worse short-term outcomes. Specifically, we found higher 30-day mortality for gastrectomy, pancreatectomy, and hepatectomy. The main mechanism here is limited access to hospitals providing high-quality cancer surgery.


"Because there is no singular measure for complex cancer surgery, we looked at several surrogate indicators (such as hospital volume, teaching hospital status, NCI-designation for cancer center, or Commission on Cancer Accreditation). Across the board with some exceptions, Medicare Advantage beneficiaries were less likely to get surgery at high-quality hospitals.


"This is the first study that specifically looks at cancer surgery outcomes. Previously, Gretchen Jacobson, PhD, (a co-author on the study with The Commonwealth Fund) had looked at Medicare Advantage plan networks and coverage of National Cancer Institute-designated cancer centers and made similar observations. Our previous work on Medicare Advantage plan networks and their inclusion of high-volume cancer surgery hospitals in Los Angeles County showed striking undercoverage for many types of complex cancer surgery (Ann Surg 2021; doi: 10.1097/SLA.0000000000005098)."


3 What would you say are the implications of these findings for patients with cancer, providers, policy makers, and others?

"Patients are not necessarily thinking specifics when they sign up for Medicare Advantage. For example, they likely are not asking themselves the following question: If I need a liver surgery, will I get to the right doctor? They see the advertised benefit of dental, vision, cap on out-of-pocket maximum, and gym membership.


"These new data [from our team] serve to inform the general public that they should be cautious and ask for specifics. A Medicare Advantage plan with great cardiac coverage may not have the best cancer surgery coverage. Current CMS rating of plans does not help the patients decide either.


"Providers-especially those offering complex cancer surgery-are already acutely aware of the inability to help patients with limitations imposed by Medicare Advantage health plans. They can use these data to counsel their patients who are thinking of transitioning their health insurance coverage. For policy makers, it would be important to set policies that incentivize access to quality cancer surgery across Medicare Advantage plans. It is important to make the details about Medicare Advantage plan coverage more transparent. It is very challenging to know which providers and hospitals are covered under a specific Medicare Advantage plan.


"The key take-home is that when it comes to patients needing complex cancer surgery, Medicare Advantage plans save cost, but this comes at a hidden cost of worse short-term outcomes."