For several decades, certain cancer centers have been allowed by the U.S. government to charge more for the care they give. A new study finds the care given at these centers isn’t very different from that received at other top-notch facilities.
Since the early 80s, the 11 centers have been exempt from the “Prospective Payment System,” meaning they are allowed to charge much higher rates for Medicare and Medicaid patients compared to similar centers without being forced to justify that price difference, according to the report in JAMA Internal Medicine.
“There does not seem to be a lot of difference between those centers and other high-end National Cancer Institute Cancer Centers,” said study coauthor Dr. Karl Bilimoria, director of the surgical outcomes and quality improvement center at Northwestern Medicine. “We think the system should be critically appraised and reevaluated from time to time and public reporting requirements should be the same across all hospitals.”
Bilimoria and colleagues found that outcomes from nine different types of cancer surgeries at the 11 exempt centers were comparable to those at 54 high-end NCI cancer centers.
The 11 centers -which aren’t required to justify their special treatment by the government, Bilimoria said - and their affiliated hospitals are the Dana Farber Cancer Institute (Boston); Brigham and Women’s Hospital (Boston); Roswell Park Comprehensive Cancer Center (Buffalo, New York); Memorial Sloan-Kettering Cancer Center (New York City); Fox Chase Cancer Center (Philadelphia); University of Miami Hospital and Clinics-Sylvester Comprehensive Cancer Center (Miami, Florida; University of Miami Hospital; H. Lee Moffitt Cancer Center and Research Institute (Tampa, Florida); The Ohio State University James Cancer Hospital (Columbus); University of Texas MD Anderson Cancer Center (Houston); Seattle Cancer Care Alliance; University of Washington Medical Center (Seattle); USC Norris Comprehensive Cancer Hospital (Los Angeles); Keck Hospital of USC (Los Angeles); and City of Hope’s Helford Clinical Research Hospital (Duarte, California).
The reasoning behind giving these centers special treatment was “so they could do more work on cancer care and research,” Bilimoria explained. But once the centers were designated by congress, “they haven’t been revisited.”
A government study that looked at nine of the 11 centers found they were paid an average of 42 percent more than others for inpatient services. The Government Accountability Office estimated that Medicare paid these nine centers in excess of $500 million more per year than the program would have paid if they had not been exempted, Bilimoria and his colleagues noted.
To see whether the higher payments to the 11 centers could be justified in terms of higher quality of care, Bilimoria and his colleagues compared their performance to the non-exempt centers on 18 types of outcomes from surgeries for cancers of the brain, colon or rectum, bladder, esophagus, stomach, liver, pancreas and prostate. While the majority of outcomes were similar, the 11 centers did score better when it came to postoperative sepsis, kidney failure, and urinary tract infection.
Bilimoria hopes his study will convince the government to take a closer look at the program and make it more competitive. “It should be available to all cancer centers and provided through an open, transparent and accessible system,” he said.
This exemption program, which is “a sort of two-tiered class system, is not widely known by the general public,” said Dr. Robert Ferris director of the Hillman Cancer Center at the University of Pittsburgh Medical Center.
Ferris agrees that the system ought to be reevaluated and other centers ought to be able to compete for the exempt designation. “If a center can meet the same metrics, why shouldn’t they qualify for higher payment,” he said.
SOURCE: bit.ly/2x0deni JAMA Internal Medicine, online June 17, 2019.