BACKGROUND: Advanced imaging and serum biomarkers are commonly used for surveillance in patients with early-stage breast cancer, despite recommendations against this practice. Incentives to perform such low-value testing may be less prominent in integrated health care delivery systems. The purpose of the current study was to evaluate and compare the use of these services within 2 integrated systems: Kaiser Permanente (KP) and Intermountain Healthcare (IH). The authors also sought to distinguish the indication for testing: diagnostic purposes or routine surveillance. METHODS: Patients with American Joint Committee on Cancer stage 0 to II breast cancer diagnosed between 2009 and 2010 were identified and the use of imaging and biomarker tests over an 18-month period were quantified, starting at 1 year after diagnosis. Chart abstraction was performed on a random sample of patients who received testing to identify the indication for testing. Multivariate regression was used to explore associations with the use of nonrecommended care. RESULTS: A total of 6585 patients were identified; 22% had stage 0 disease, 44% had stage I disease, and 34% had stage II disease. Overall, 24% of patients received at least 1 imaging test (25% at KP vs 22% at IH; P 5.009) and 28% of patients received at least 1 biomarker (36% at KP vs 13% at IH; P<.001). Chart abstraction revealed that 84% of imaging tests were performed to evaluate symptoms or signs. Virtually all biomarkers were ordered for routine surveillance. Stage of disease, medical center that provided the services, and provider experience were found to be significantly associated with the use of biomarkers. CONCLUSIONS: Advanced imaging was most often performed for appropriate indications, but biomarkers were used for nonrecommended surveillance. Distinguishing between inappropriate use for surveillance and appropriate diagnostic testing is essential when evaluating adherence to recommendations. Cancer 2016;122:908-16.
The prices that private insurers pay hospitals have received considerable
attention in recent years, but most of that literature has focused on the
commercially insured population. Although nearly one-third of Medicare
beneficiaries are enrolled in a Medicare Advantage (MA) plan, little is known
about the prices paid to hospitals by the private insurers that administer such
plans. More information on the hospital prices paid by MA plans would provide
additional insights into whether MA prices are more closely tied to Medicare
fee-for-service (FFS) prices or commercial prices. Moreover, information on
whether the hospital prices paid by MA plans vary with market characteristics or
other factors would be useful for evaluating the performance of the MA program
and analyzing proposals to modify it. In this study, we compared the hospital
prices paid by MA plans and commercial plans with Medicare FFS prices using 2013
claims from the Health Care Cost Institute (HCCI) database. The HCCI claims were
used to calculate hospital prices for private insurers, and Medicare’s payment
rules were used to estimate Medicare FFS prices. We focused on stays at acute
care hospitals in metropolitan statistical areas (MSAs). We found MA prices to
be roughly equal to Medicare FFS prices, on average, but commercial prices were
89% higher than FFS prices. In addition, commercial prices varied greatly across
and within MSAs, but MA prices varied much less.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.