Comparison of Hospitals Affiliated With PPS-Exempt Cancer Centers, Other Hospitals Affiliated With NCI-Designated Cancer Centers, and Other Hospitals That Provide Cancer Care

Abstract

IMPORTANCE Congress has exempted 11 specialized cancer centers in the United States from the Prospective Payment System (PPS). These centers are also exempt from reporting many of the process-of-care and outcome measures to the Centers for Medicare & Medicaid Services that are required for hospitals in the PPS. It is not known how hospitals affiliated with PPS-exempt cancer centers differ from other hospitals affiliated with National Cancer Institute cancer centers (NCI-CCs) or other US hospitals that provide cancer care. OBJECTIVE To examine differences between hospitals affiliated with PPS-exempt cancer centers, other hospitals affiliated with NCI-CCs, and other hospitals that provide cancer care on metrics that could be used in public reporting. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study compared hospital characteristics and cancer-related services using data from the American Hospital Association Annual Survey and US News Best Hospitals rankings. With a 100% sample of Medicare beneficiaries who underwent 1 of 9 cancer operations (brain tumor resection, colorectal resection, cystectomy, esophagectomy, gastrectomy, liver resection, lung resection, pancreatic resection, prostatectomy) from January 1, 2011, to May 31, 2015, we used hierarchical logistic regression methods to compare differences in 18 postoperative outcomes. Data analysis was conducted from February 2018 to August 2018. MAIN OUTCOMES AND MEASURES This study evaluated hospital characteristics, including cancer-specific services, patient comorbidity burden, and cancer surgery postoperative outcomes, from PPS-exempt cancer centers, NCI-affiliated cancer centers, and other US hospitals that provide cancer care. RESULTS Hospitals affiliated with PPS-exempt cancer centers (n = 15) and NCI-CCs (n = 54) were similar in hospital characteristics, basic cancer-related services, and patient comorbidity burden. Compared with NCI-CCs, PPS-exempt cancer centers had significantly higher US News reputation scores (mean [SD], 17.5 [24.0] vs 2.6 [4.8]; P < .001) but no differences in oncology patient volume, patient safety ratings, comorbidity burden, nurse staffing, US News total cancer scores, or US News survival scores. Hospitals affiliated with PPS-exempt cancer centers and NCI-CCs had similar adjusted postoperative outcomes for 15 of 18 measures, including mortality, readmission, and surgical site infections. Compared with hospitals affiliated with PPS-exempt cancer centers, patients treated at NCI-CCs were more likely to have postoperative sepsis (3.1% vs 1.7%; P = .002), acute renal failure (6.2% vs 3.9%; P = .01), and urinary tract infection (6.4% vs 4.0%; P = .002). Compared with the other hospitals that provide cancer care (n = 3578), PPS-exempt cancer center status was associated with improved outcomes for 7 of 18 measures, including mortality, sepsis, acute renal failure, pulmonary failure, and failure to rescue. CONCLUSIONS AND RELEVANCE Hospitals affiliated with PPS-exempt cancer centers and NCI-CCs had generally similar hospital...

Community-based Cancer Care Quality and Expertise in a COVID-19 Era and Beyond

“…And even though >80% of newly diagnosed cancer patients elect to be cared for in a community-based setting, studies from large academic medical centers have suggested that patients live longer when treated at specific academic hospital systems—a conclusion that has historically allowed such centers to avoid government-mandated payments and quality reporting processes. 1 , 2 However, a recent study has brought the rationale for this exclusionary payment benefit into question by demonstrating equivalent quality-related metrics for cancer patients treated in diverse cancer care settings. 2 Regardless, cancer-related health care expenditures have continued to rise systemically without a proportional improvement in cancer-related outcomes.…”

“… 1 , 2 However, a recent study has brought the rationale for this exclusionary payment benefit into question by demonstrating equivalent quality-related metrics for cancer patients treated in diverse cancer care settings. 2 Regardless, cancer-related health care expenditures have continued to rise systemically without a proportional improvement in cancer-related outcomes. 3 In this COVID-19 era and beyond, through efforts to limit exposure risks for vulnerable cancer patients and care teams, a renewed focus on concepts of quality, value, and expertise will be necessary to allow community-based cancer programs to shoulder a greater burden for cancer care services delivered closer to home.…”

“… 6 However, in an era of major advancements in radiotherapy, systemic treatment options, and emerging technologies, cancer-related outcomes and patient experiences in community settings may be hypothesized to be on par if not better than large reputable academic centers for the large majority of cancer cases. 2 This translates to the idea that community-based cancer expertise, born out of clinical experience and acumen, is important to recognize and support in large tertiary-care community-based cancer programs that seek to reassure patients that their care will be of the highest quality.…”

A Textbook Answer to the Debate About Medicare’s Prospective Payment System Exemption?

“…35,6 Our recent study, evaluating both surgical and nonsurgical cancer care, demonstrated that few differences in hospital characteristics, patient characteristics, or outcomes exist between PCHs and National Cancer Institute (NCI)-designated Cancer Centers. 3 In this issue of Annals of Surgical Oncology, Mehta et al 7 report the results of their study evaluating outcomes of hepatic and pancreatic surgery at PCHs. They use textbook outcome (TO), a recently described composite outcome measure defined as the absence of complications, prolonged length of stay, mortality, or readmission within 90 days after discharge.…”

Using Center-Specific Medicare Data to Compare Cancer Care Outcomes: Are We Seeing the Whole Playing Field or Just a Blade of Grass

“…As such, in the same way that we could never use these limited data sets to justify the continued existence of the PPS exemption for the ADCCs, we should not weaponize these data to argue that the exemption should be stripped away, as was recently done. 3 The Medicare data set is simply not the right scale for that measurement. The outcomes for a relatively small number of older cancer patients with a unique combination of stage, performance status, access, and favorable biology that afforded them the opportunity for a complex operation almost a decade ago cannot and should not be used to set (or even comment on) health policy regarding future payment models for global cancer care in the United States.…”