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Medicare (Dis)Advantage: A Detriment to Cancer Patients

Summary: A study of cancer surgery finds higher mortality in Medicare Advantage than in Traditional Medicare. The apparent reason? Less use of prestigious and highly experienced hospitals for complex cancer surgeries.

Medicare Advantage: A Disadvantage for Complex Cancer Surgery Patients
Journal of Clinical Oncology
November 10, 2022
By Mustafa Raoof et al.

From the Discussion:

Medicare Advantage (MA) plans cut health care utilization by restricting beneficiary options to certain in-network providers or hospitals. Similarly, MA plans save cost by regulating the use of specialists through utilization-management techniques such as prior authorization. In this study, we sought to assess the outcomes of complex cancer surgery among Traditional Medicare (TM) and MA beneficiaries. We reasoned that utilization-management techniques used by MA plans may restrict access of the beneficiaries to high-volume specialists and hospitals.

The main finding of the study is that MA beneficiaries have significant barriers in accessing optimal surgical cancer care. For instance, except for pancreatic operations, MA beneficiaries were more likely to wait longer between diagnosis and therapy compared with TM beneficiaries. Furthermore, MA beneficiaries were significantly less likely to receive care at teaching hospitals, CoC-accredited hospitals, or NCI-designated centers. …

For liver, pancreas, or stomach operations, limited access of MA beneficiaries to high-volume hospitals likely contributed to worse 30-day mortality.

Comment by: Isabel Ostrer

Nearly half of Medicare beneficiaries are enrolled in privatized Medicare Advantage (MA) plans as older Americans are increasingly siphoned away from Traditional Medicare (TM). A new study by Raoof et al. examines how costs and outcomes compare for complex cancer surgery patients in MA vs TM. Costs were significantly lower for MA compared with TM.

But monetary savings come at a serious health cost. Compared with TM beneficiaries, MA beneficiaries had significant delays from diagnosis to surgery. Those with stomach, pancreas, and liver cancer had much higher 30-day mortality rates – because they were less likely to receive care in hospitals with extensive experience (“high volume”) for the relevant complex surgeries.

MA plans are able to cut costs by restricting access to life-saving care, for example, by using prior authorization and narrow networks. It’s no surprise that MA beneficiaries have to wait longer for therapy. It’s unacceptable that they receive care at less experienced hospitals, resulting in added deaths. This adds to a recent study on MA finding no mortality benefit (at best) for acute myocardial infarction despite known higher MA costs to CMS.

Controlling health care costs should not come at the expense of patient well-being. Single payer does both: saves money and improves health.

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