Study Finds Avoidable Hospitalizations After Chemotherapy More Likely with Medicare

Veterans with cancer who received chemotherapy in the Veterans Health Administration have a higher quality of care as measured by avoidable hospitalizations than veterans with cancer who received chemotherapy through Medicare, according to a recent study published in Cancer.

These results indicate that a concerted effort is necessary to ensure quality of care for veterans does not decline as more veterans utilize the private sector via the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act.

“Our work indicates that the likelihood of potentially avoidable hospitalizations for veterans with cancer is higher for those treated in Medicare versus those treated by the (Veterans Health Administration),” wrote the researchers. “However, this may be mitigated or eliminated if Medicare hospitals respond to the financial incentives accompanying this quality measure, which will be implemented in 2020.”

This evaluation used a cohort of cancer decedents between 2010-2014, with patients being veterans aged 66 years or older at the time of death who were dually enrolled in Medicare and the Veterans Health Administration. Using hierarchical generalized estimating equations, the study then compared the proportions of patients with potentially avoidable hospitalizations.

Notably, the Centers for Medicare and Medicaid Services defines avoidable hospitalizations as “those related to anemia, dehydration, diarrhea, emesis, fever, nausea, neutropenia, pain, pneumonia, or sepsis in the 30 days after chemotherapy.”

A total of 27,443 patients received outpatient chemotherapy. The data found that the patients receiving chemotherapy through Medicare were statistically significantly more likely to experience avoidable hospitalizations than those receiving chemotherapy through the Veterans Health Association (adjusted odds ratio, 1.58; 95% CI, 1.41-1.78; P< 0.001).

Specifically, in predicted estimates, researchers suggested that 7.1% of Medicare-treated veterans had avoidable hospitalizations in the 30 days after chemotherapy compared to 4.6% of Veterans Health Association-treated patients.

“Due to the Choice and MISSION Acts, veterans, especially those older than 65 years, will increasingly have an opportunity to receive care in the private sector,” wrote the researchers. “For veterans receiving chemotherapy, this may expose them to more inpatient stays.”

The researchers emphasized a handful of limitations to their research, including the lack of randomization in assigning veterans to a system. Because of this, there may be unmeasured differences in the type of veteran who seeks Medicare versus the Veterans Health Administration.

More, the researchers did not include chemotherapy data from the Medicare Carrier file with the goal of maintaining fidelity to the Centers for Medicare and Medicaid Services data. As a result, this likely undercounted outpatient chemotherapy and subsequent potentially avoidable hospitalizations.

“Our findings highlight the importance of understanding health system variations in the frequency of unplanned hospital visits that could potentially be avoidable in the 30 days after chemotherapy,” wrote the researchers.

Reference:

Gidwani-Marszowski R, Faricy-Anderson K, Asch SM, et al. Potentially Avoidable Hospitalizations After Chemotherapy: Differences Across Medicare and the Veterans Health Administration. Cancer. DOI: 10.1002/cncr.32896.