Medicare spending for cancer care varied widely in different regions of the country, yet survival rates remained much the same, according to a new study that confirmed the need for more scrutiny of the recommendations being made by physicians.
Regions spending more Medicare money on cancer care aren’t finding better results, suggesting that any potential budget cuts might not be as detrimental as once believed.
The findings were published last week in the Journal of the National Cancer Institute.
Cancer care accounts for an estimated 10 percent of all Medicare spending, especially significant during a national debate over fiscal responsibility in all federal government programs.
This study, headed by Gabriel Brooks, M.D., of the acclaimed Dana-Farber Cancer Institute in Boston, was designed to determine a link between spending and advanced cancer survival.
“The main finding of our research is that there are large variations across the U.S. in spending for advanced cancer care, but these regional spending variations are not associated with differences in survival,” Brooks told Asbestos.com. “I am certainly not trying to suggest that patients should forego needed care just because that care may be high cost. Rather, I believe that patients and doctors should work together to establish realistic goals and expectations about treatments.”
No Link Between Spending and Survival
The study found a 32 percent difference in spending from one region to another among patients who did not die from their cancers. There was a 41 percent regional spending difference among patients who died. There was negligible difference in survival rates in either group.
Brooks said the study also found that higher-spending regions tended to have longer and more frequent hospital stays, and lower hospice referrals.
“The identification of inpatient hospitalization as a key driver in regional variations in 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,” the study authors wrote. “Our findings suggest that health-care providers should be incentivized to develop strategies aimed at reducing potentially avoidable hospitalizations and increasing timely access to palliative care.”
The Medicare study was done with advanced lung, breast, pancreatic, colorectal and prostate cancers. Although lung cancer can be caused by asbestos exposure, the study did not include patients with mesothelioma, another cancer caused by asbestos. The researchers used both National Cancer Institute and Medicare data from 2002 to 2007. More than 100,000 Medicare beneficiaries were used in the study.
Although the study has been well received, the idea of incentivizing physicians to shorten hospital stays has left others uneasy with the process.
“When we give doctors and hospitals financial incentives, the doctors and hospitals will, at least in many cases, shape their clinical care based on their own financial gain, and that’s disturbing,” David Himmelstein, professor at the City University of New York School of Public Health at Hunter College, told Kaiser Health News.