Episode-of-care spending over 30 days after cancer-directed surgery significantly dropped among Medicare beneficiaries after shifting to more outpatient care, a cross-sectional study showed.
Among over 70,000 Medicare fee-for-service beneficiaries, inflation- and covariate-adjusted mean 30-day episode surgery expenditures decreased from $23,630 in 2011 to $20,239 in 2019, which corresponded to an annual change of -2.15% (95% CI -2.32 to -1.97), reported Anaeze C. Offodile II, MD, MPH, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues.
When looking at specific settings, expenditures for outpatient surgery stayed relatively stable, with an annual change of 0.02% (95% CI -0.04 to 0.07), while adjusted episode spending on inpatient surgeries dropped from $31,964 in 2011 to $27,418 in 2019 (annual change -2.27%, 95% CI -2.43 to -2.12), the authors noted in a research letter published in JAMA Surgery.
"This overall decrease was largely attributable to lower spending associated with inpatient procedures and a concomitant increase in the proportion of surgeries performed in the less-expensive outpatient setting," Offodile and team wrote."These results have important implications for policy and clinical practice, particularly because the absolute number of patients with cancer aged 65 years or older is projected to nearly double from 52 million in 2018 to 95 million by 2060."
"The increasing use of minimally invasive approaches may have catalyzed the shift to outpatient surgery, while broad-based improvements in perioperative care (i.e., care standardization, implementation of enhanced recovery protocols, and multidisciplinary teams) may have led to reductions in surgical morbidity and mortality, contributing to the declines in 30-day episode spending for cancer-directed surgery," they added.
Over the study period, the proportion of outpatient surgeries jumped from 30.3% to 46.7% (annual change 1.95%, 95% CI 1.81-2.09).
"The main finding was surprising because overall healthcare costs have been increasing," co-author Alexander Melamed, MD, MPH, of Massachusetts General Hospital in Boston, told MedPage Today. "Important future work would seek to describe the mechanisms underlying the observed trends in expenditures to develop interventions and policies which may further increase the value of cancer care in the U.S."
Cancer is a disease of aging, and most cancer-related spending occurs among Medicare beneficiaries, the authors noted, with the current Baby Boomer population expected to pose a challenge for oncologists. Studies have predicted a 34% increase in cancer care spending, reaching $246 billion by the year 2030.
A large portion of spending occurs in the first year after patients are diagnosed with cancer, which is mostly attributed to cancer-directed surgery. Despite this, limited data are available on the trajectory of resource utilization linked to cancer-directed surgery for Medicare beneficiaries. Outpatient care may be a better option for Medicare patients, with a recent report from the HHS Office of Inspector General showing that one in four Medicare patients were harmed during hospital stays, and nearly half of these cases were preventable.
For this study, Offodile and colleagues examined data on 70,324 Medicare fee-for-service beneficiaries who underwent excisional or ablative surgery for cancer from January 2011 through December 2019. Surgery-related expenditures included all Medicare Part A claims -- hospitals, home health agencies, skilled nursing facilities, and hospice organizations -- in addition to Part B claims, including laboratories, healthcare practitioners, imaging, and durable medical equipment.
Using the Consumer Price Index for Medical Care, payments were adjusted for inflation to U.S. dollars in 2019. The researchers used one set of estimates to adjust for inflation expenditures, followed by a second set adjusted for demographics, type of cancer, dual eligibility, and comorbidities.
Median patient age was 74, and 64.5% were women. The most common cancer diagnoses were breast (37%), colorectal (15.1%), lung (9.3%), and prostate cancers (9.3%).
Offodile and team acknowledged that their results may not be generalizable to younger patients or those enrolled in Medicare Advantage programs.
Disclosures
Offodile reported receiving grants from Blue Cross Blue Shield, the Rising Tide Foundation for Clinical Cancer Research, the MD Anderson University Cancer Foundation, and the National Academy of Medicine, and receiving honoraria from the Indiana University and University of Tennessee departments of surgery.
Melamed reported receiving grants from the National Center for Advancing Translational Sciences, the National Cancer Institute, Conquer Cancer-The ASCO Foundation, and the National Academy of Medicine.
One co-author reported relationships with CMS, the National Cancer Institute, the Agency for Healthcare Research and Quality, Arnold Ventures, the Commonwealth Fund, and the Research Triangle Institute.
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.