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Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance

IMPORTANCE: With rising expenditures on cancer care outpacing other sectors of the US health system, national attention has focused on insurer spending, particularly for patients with private insurance, for whom price transparency has historically been lacking. The type of hospital at which cancer c...

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Autores principales: Takvorian, Samuel U., Yasaitis, Laura, Liu, Manqing, Lee, Daniel J., Werner, Rachel M., Bekelman, Justin E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8335573/
https://www.ncbi.nlm.nih.gov/pubmed/34342648
http://dx.doi.org/10.1001/jamanetworkopen.2021.19764
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author Takvorian, Samuel U.
Yasaitis, Laura
Liu, Manqing
Lee, Daniel J.
Werner, Rachel M.
Bekelman, Justin E.
author_facet Takvorian, Samuel U.
Yasaitis, Laura
Liu, Manqing
Lee, Daniel J.
Werner, Rachel M.
Bekelman, Justin E.
author_sort Takvorian, Samuel U.
collection PubMed
description IMPORTANCE: With rising expenditures on cancer care outpacing other sectors of the US health system, national attention has focused on insurer spending, particularly for patients with private insurance, for whom price transparency has historically been lacking. The type of hospital at which cancer care is delivered may be an important factor associated with insurer spending for patients with private insurance. OBJECTIVE: To examine differences in spending and utilization for patients with private insurance undergoing common cancer surgery at National Cancer Institute (NCI) centers vs community hospitals. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study included adult patients with an incident diagnosis of breast, colon, or lung cancer who underwent cancer-directed surgery from 2011 to 2014. Mean risk-adjusted spending and utilization outcomes were examined for each hospital type using multilevel generalized linear mixed-effects models, adjusting for patient, hospital, and region characteristics. Data were collected from the Health Care Cost Institute’s national multipayer commercial claims data set, which encompasses claims paid by 3 of the 5 largest commercial health insurers in the United States (ie, Aetna, Humana, and UnitedHealthcare). Data analyses were conducted from February 2018 to February 2019. EXPOSURES: Hospital type at which cancer surgery was performed: NCI, non-NCI academic, or community. MAIN OUTCOMES AND MEASURES: Spending outcomes were surgery-specific insurer prices paid and 90-day postdischarge payments. Utilization outcomes were length of stay (LOS), emergency department (ED) use, and hospital readmission within 90 days of discharge. RESULTS: The study included 66 878 patients (51 569 [77.1%] women; 31 585 [47.2%] aged ≥65 years) with incident breast (35 788 [53.5%]), colon (21 378 [32.0%]), or lung (9712 [14.5%]) cancer undergoing cancer surgery at 2995 hospitals (5522 [8.3%] at NCI centers; 10 917 [16.3%] at non-NCI academic hospitals; 50 439 [75.4%] at community hospitals). Treatment at NCI centers was associated with higher surgery-specific insurer prices paid compared with community hospitals ($18 526 [95% CI, $16 650-$20 403] vs $14 772 [95% CI, $14 339-$15 204]; difference, $3755 [95% CI, $1661-$5849]; P < .001) and 90-day postdischarge payments ($47 035 [95% CI, $43 289-$50 781] vs $41 291 [95% CI, $40 350-$42 231]; difference, $5744 [95% CI, $1659-9829]; P = .006). There were no significant differences in LOS, ED use, or hospital readmission within 90 days of discharge. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, surgery at NCI centers vs community hospitals was associated with higher insurer spending for a surgical episode without differences in care utilization among patients with private insurance undergoing cancer surgery. A better understanding of the factors associated with prices and spending at NCI cancer centers is needed.
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spelling pubmed-83355732021-08-05 Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance Takvorian, Samuel U. Yasaitis, Laura Liu, Manqing Lee, Daniel J. Werner, Rachel M. Bekelman, Justin E. JAMA Netw Open Original Investigation IMPORTANCE: With rising expenditures on cancer care outpacing other sectors of the US health system, national attention has focused on insurer spending, particularly for patients with private insurance, for whom price transparency has historically been lacking. The type of hospital at which cancer care is delivered may be an important factor associated with insurer spending for patients with private insurance. OBJECTIVE: To examine differences in spending and utilization for patients with private insurance undergoing common cancer surgery at National Cancer Institute (NCI) centers vs community hospitals. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study included adult patients with an incident diagnosis of breast, colon, or lung cancer who underwent cancer-directed surgery from 2011 to 2014. Mean risk-adjusted spending and utilization outcomes were examined for each hospital type using multilevel generalized linear mixed-effects models, adjusting for patient, hospital, and region characteristics. Data were collected from the Health Care Cost Institute’s national multipayer commercial claims data set, which encompasses claims paid by 3 of the 5 largest commercial health insurers in the United States (ie, Aetna, Humana, and UnitedHealthcare). Data analyses were conducted from February 2018 to February 2019. EXPOSURES: Hospital type at which cancer surgery was performed: NCI, non-NCI academic, or community. MAIN OUTCOMES AND MEASURES: Spending outcomes were surgery-specific insurer prices paid and 90-day postdischarge payments. Utilization outcomes were length of stay (LOS), emergency department (ED) use, and hospital readmission within 90 days of discharge. RESULTS: The study included 66 878 patients (51 569 [77.1%] women; 31 585 [47.2%] aged ≥65 years) with incident breast (35 788 [53.5%]), colon (21 378 [32.0%]), or lung (9712 [14.5%]) cancer undergoing cancer surgery at 2995 hospitals (5522 [8.3%] at NCI centers; 10 917 [16.3%] at non-NCI academic hospitals; 50 439 [75.4%] at community hospitals). Treatment at NCI centers was associated with higher surgery-specific insurer prices paid compared with community hospitals ($18 526 [95% CI, $16 650-$20 403] vs $14 772 [95% CI, $14 339-$15 204]; difference, $3755 [95% CI, $1661-$5849]; P < .001) and 90-day postdischarge payments ($47 035 [95% CI, $43 289-$50 781] vs $41 291 [95% CI, $40 350-$42 231]; difference, $5744 [95% CI, $1659-9829]; P = .006). There were no significant differences in LOS, ED use, or hospital readmission within 90 days of discharge. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, surgery at NCI centers vs community hospitals was associated with higher insurer spending for a surgical episode without differences in care utilization among patients with private insurance undergoing cancer surgery. A better understanding of the factors associated with prices and spending at NCI cancer centers is needed. American Medical Association 2021-08-03 /pmc/articles/PMC8335573/ /pubmed/34342648 http://dx.doi.org/10.1001/jamanetworkopen.2021.19764 Text en Copyright 2021 Takvorian SU et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Takvorian, Samuel U.
Yasaitis, Laura
Liu, Manqing
Lee, Daniel J.
Werner, Rachel M.
Bekelman, Justin E.
Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance
title Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance
title_full Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance
title_fullStr Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance
title_full_unstemmed Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance
title_short Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance
title_sort differences in cancer care expenditures and utilization for surgery by hospital type among patients with private insurance
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8335573/
https://www.ncbi.nlm.nih.gov/pubmed/34342648
http://dx.doi.org/10.1001/jamanetworkopen.2021.19764
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