Cancer Surgery Access in MA

Medicare Advantage uses private health plans to deliver Medicare benefits.  Some version of these plans has been around for almost 30 years.  The plans cover over half of all beneficiaries.  While there are clear issues with the payment methods that likely have resulted in significant overpayments to the plans, one thing that consistently has been shown is that the quality of care is better in MA plans than is fee-for-service Medicare, which basically does nothing to really monitor or manage care.  So this piece of research is surprising, until you look at where the authors come from.  Large, supposedly “premier” medical centers try to charge a fortune for their service, resulting in higher costs for health insurers and consumers.  They aren’t happy when health plans, including the MA plans, try to put a limit on their absurdly high costs and cost increases year-after-year.

So the first thing to know about this particular study is that the authors are based at the very same medical facilities that they claim are not widely available to MA beneficiaries.  The premise of the study is that MA members don’t have access to the highest quality cancer surgery centers.  How you define quality is quite subjective and people tend to be selective about the measures that they use.  And of course, as usual, when you are comparing groups of anything ensuring that all confounders, all relevant variables explaining any differences, have been considered is critical.

The authors’ title gives the game away, it is called “Access to High Quality Hospitals Among Medicare Advantage Beneficiaries Undergoing Cancer Surgery”.  So what is a high quality hospital?  It was defined solely as “procedure-specific, risk and reliability adjusted mortality”.  The study period ended in 2022.  I am always suspicious when people aren’t using the most recent data.  Why not consider other measures of “quality” which are available?  And a “high quality” hospital was just one in the top 20% on this limited quality measure.  What was wrong with the next 20%, clearly above average.    The differences are pretty minor, for one procedure cited by the authors, 21.7% of traditional Medicare beneficiaries had surgery at a high quality hospital versus 17.3% for MA.     (JAMA Article)

Pretty clear that this article is basically a hit job on behalf of expensive medical centers that resent having their prices reined in by health plans.