Medicare Advantage: A Disadvantage for Complex Cancer Surgery Patients

Area of Science:

• Health Services Research
• Oncology
• Health Economics

Background:

• Nearly half of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans.
• Limited comparative data exists on access, outcomes, and costs of inpatient cancer surgery between MA and Traditional Medicare (TM).

Purpose of the Study:

• To compare access to high-volume hospitals, postoperative outcomes, and estimated costs of inpatient cancer surgery between MA and TM beneficiaries.
• To assess differences in mortality and complications for specific cancer surgeries under MA versus TM.

Main Methods:

• Retrospective cohort analysis of 76,655 Medicare beneficiaries undergoing elective inpatient cancer surgery from 2000-2020.
• Data from the California Inpatient Database and California Cancer Registry were used to compare MA and TM beneficiaries.
• Risk-standardized access, 30-day mortality, complications, and estimated costs were analyzed for various cancer sites.

Main Results:

• MA beneficiaries were less likely to receive care at high-volume hospitals for most cancer sites, except colon surgery.
• Significantly higher 30-day mortality was observed for MA beneficiaries undergoing gastrectomy, pancreatectomy, and hepatectomy compared to TM.
• MA beneficiaries incurred lower estimated hospital costs for inpatient cancer surgery.

Conclusions:

• Medicare Advantage enrollment is associated with lower estimated hospital costs for cancer surgery.
• However, MA beneficiaries face reduced access to high-volume centers and experience increased mortality for specific gastrointestinal and liver surgeries compared to Traditional Medicare beneficiaries.