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Difference In What Medicare Spends On Cancer Care May Not Affect Survival Rates

By Alvin Tran

March 12th, 2013, 4:05 PM

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.”

This article was produced by Kaiser Health News with support from The SCAN Foundation.

5 Responses to “Difference In What Medicare Spends On Cancer Care May Not Affect Survival Rates”

  1. C Ozeran says:

    Two points: how often do patients and families promote the use of more intensive and/or invasive treatments in the desire to “do everything”, especially after the recent public outry about “death panels” which might make them more fearful that they are being denied care that might cure their disease? Does anyone ever admit to them that at some point there is no possible cure? Second, independent of patient/family awareness, how often do providers recommed hospice care at a reasonable point (not just a week before death is imminent)? I have seen multiple studies that show providers still don’t discuss hospice soon enough. Both patients and providers need more education around acceptance of death and dying, and the benefits of less invasive, palliative care. Some patients will still choose “do everything” but others may not.

  2. PAUL A. says:

    hospitals could start hospice care right in the facility and get a new revenue center.

  3. David says:

    As an oncologist in private practice, it amazes me that physicians do not feel comfortable talking about death. I have worked with dozens of oncologists, and only a handful seem to acknowledge the inevitable. The only way to change habits is to stop paying for ineffective treatments. If you pay oncologist for 3rd line treatment (and put money in their pockets), you incentive their actions. If you don’t pay for it, their habits will change soon and they will learn how to talk to patients. Same with families, if you make them put more skin in the game, they will stop pushing for more. Most families regret pushing only when it’s too late. What a shame for our field.

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  5. Lucille H Weisbein says:

    Interesting & frightening article.! I plan to
    Forward this article to my Geriatric Dr,
    Thankyou Dr Brooks.