Although Medicare spending for patients with advance cancers varies regionally, a new study suggests that those differences are not related to survival rates.
The study, published Tuesday in the Journal of the National Cancer Institute, examined Medicare spending on patients with advanced lung, colorectal, pancreatic, breast, and prostate cancers. Cancer care costs account for approximately 10 percent of Medicare payments and effective treatments to “prolong survival in this population are limited,” the researchers noted.
The researchers, using Medicare and National Cancer Institute data from 2002 to 2007, probed regional spending on these advanced cancer patients. They divided their patient population, which included more than 100,000 Medicare beneficiaries, into two overlapping groups: those newly diagnosed with an advanced-stage cancer and those who have died from cancer.
The researchers found that Medicare spending varied widely: For patients who did not die from their cancers, there was a 32 percent difference in spending among the regions. For patients who died, the spending difference varied 41 percent among regions.
“Increased spending is associated with more frequent and longer hospital visits, more intensive care, and decreased rates of hospice use,” the researchers conclude. “The identification of inpatient hospitalization as a key driver of regional variation in advanced cancer spending is an important finding at a time when much attention on the cost of cancer care has been focused on the cost of chemotherapy.”
They recommended that incentives be used to encourage doctors to reduce hospitalizations and make better use of palliative care for patients.
Dr. Gabriel Brooks, a fellow in medical oncology at Dana-Farber Cancer Institute in Boston and the study’s lead author, said in an interview that the variation in spending without a noticeable improvement in survival rates calls into question the value of the care these patients are getting.
“It suggests that we may not be giving the most symptom-focused care to some of these patients,” Brooks said. Still, he said there were indications in the study that in at least some aspects of care, physicians have consistent practices across the country, including the use of chemotherapy and other outpatient services such as CT scans.
Dr. David Himmelstein, a professor at the City University of New York School of Public Health at Hunter College and co-founder of Physicians for a National Health Program, said the study confirms “what we thought before, which is that the amount of hospitalization is an important driver of variability in costs and that cancer costs vary very widely.”
But he cautioned that the study authors’ call for incentives to change doctors’ practices may not be wise.
“When we give doctors and hospitals financial incentives, the doctors and hospital will, at least in many cases, shape their clinical care based on their own financial gain — and that’s disturbing,” he said. “I think we need a health care financing system that is neutral in terms of incentives.”