Identifying Cancer-Directed Surgeries in Medicare Claims: A Validation Study Using SEER-Medicare Data

Area of Science:

• Health Services Research
• Oncology
• Health Informatics

Background:

• Medicare claims offer extensive data for national quality assessment.
• Accurate cancer surgery quality assessment requires reliable patient identification.
• Current administrative claims lack cancer site and diagnosis dates, necessitating validation methods.

Purpose of the Study:

• To develop and test an approach for identifying cancer-directed surgeries using only Medicare fee-for-service claims.
• To determine the feasibility of using Medicare claims for large-scale quality assessment of cancer surgery.

Main Methods:

• Utilized the SEER-Medicare-linked database as the gold standard.
• Developed and validated a method to identify cancer surgeries from Medicare claims for 17 primary cancer sites.
• Assessed the percentage of cancer surgeries identified and the proportion of identified surgeries that were for cancer patients.

Main Results:

• Successfully identified a high percentage of cancer-directed surgeries across various sites, ranging from 62% (skin melanoma) to 94% (prostate).
• Over 80% of cancer surgeries were identified using Medicare claims for most cancer sites.
• More than 90% of identified surgeries were confirmed to be for cancer patients.

Conclusions:

• Identifying cancer-directed surgeries from Medicare claims is feasible for numerous cancer types.
• The developed approach supports the use of Medicare claims for robust, large-scale quality assessment of cancer surgery.
• Site-specific validation is crucial when using Medicare claims for quality reporting.