Cost and Outcomes of Cancer Surgery in Patients Eligible for Both Medicare and Medicaid in High-Quality Hospitals

Although treatment at high-quality hospitals mitigated the disparity in outcomes of and spending for 4 elective, high-risk, cancer surgical procedures between patients eligible for Medicare alone (single eligible) and those eligible for both Medicare and Medicaid (dual eligible), dual-eligible patients still had poorer outcomes and incurred higher spending when compared with single-eligible patients, according to a recent study (JAMA Surg. 2022;157(4):e217586. doi:10.1001/jamasurg. 2021.7586). 

A retrospective, cohort study evaluated the outcomes of and spending for 119,757 Medicare beneficiaries who had inpatient colectomy, rectal resection, lung resection, or pancreatectomy for cancer performed at acute care hospitals from January 2014 through December 2018. 

Researchers pursued the comparison between dual- and single-eligible patients because “[d]ual-eligibility has previously been shown to be a more powerful marker of social risk and poor outcomes than other factors, such as race and ethnicity and neighborhood factors,” wrote Kathryn Taylor, MD, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, and colleagues.

Much of the disparity in spending occurred because dual-eligible patients were statistically significantly more likely to be discharged to a facility than were single-eligible patients and therefore incurred greater costs for postacute care. Moreover, “differences in postacute care persisted even after accounting for postoperative complications,” wrote Dr Taylor and team.

To conduct the study, the researchers used the Medicare Provider Analysis and Review file for nonfederal acute care hospitals to identify patients who were having 1 of the 4 elective oncologic surgical procedures as reflected in ICD-10 procedure codes. The resulting cohort of patients selected included fee-for-service Medicare beneficiaries who were aged between 65 and 99 years and had continuous Part A and B coverage 3 months before and 6 months after their surgery. The researchers analyzed the data collected on the cohort between November 2020 and April 2021.

The mean age of the cohort was 75 years. Slightly more than half (52%) of the cohort were women; 6.4% were Black, 89% were White, and 5% were another race or ethnicity. Eleven percent of the patients in the cohort were dual eligible.

The differences in likelihood of discharge to a facility by procedure for single- vs. dual-eligible patients, respectively, were 15% vs 24% for colectomy, 18.7% vs 27% for prostatectomy, 11% vs. 18% for lung resection, and 24% vs. 30% for pancreatectomy.

In addition, when compared with patients treated at the lowest-quality hospitals, dual-eligible patients treated at highest-quality hospitals had a better rate of discharge to a facility (23% vs. 19%, respectively) and lower spending ($22,577 vs. $20,100). Nevertheless, even at the highest-quality hospitals, these measures were still elevated for dual-eligible patients compared with single-eligible patients.

“Our results suggest that improvement in hospital quality may reduce but not eliminate disparities. To address disparities by social risk, these results call for a multifaceted approach, including quality improvement and investment in greater social support,” Dr Taylor and team concluded.