This article is more than 5 years old. Information may no longer be current.
Medicare claims data appear adequate for evaluation of hospital performance
Click Here to Manage Email Alerts
The use of Medicare claims alone to identify, risk adjust and assess outcomes appeared to adequately represent cancer care at the hospital level, according to study results.
Although the quality of care appears inconsistent throughout the country, these results suggest that SEER–Medicare data — although informative regarding disease-specific information and individual patient outcomes — may not be routinely needed for hospital-level performance measures.
Peter B. Bach
“Decades of cancer research have demonstrated that outcomes of cancer treatment vary widely in relation to where patients receive their care, and there are widespread concerns about cancer costs," Peter B. Bach, MD, MAPP, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center, and colleagues wrote. “Although survival is perhaps the most important outcome to patients with cancer and can be readily ascertained from administrative data, researchers hesitate to rely on administratively derived data for risk adjustment owing to concerns that comparisons between hospitals will be confounded by underlying differences in treated populations.”
Medicare administrative data may lack cancer-specific information such as disease staging and timing of diagnosis, according to study background.
Bach and colleagues sought to evaluate hospital performance using Medicare data for outcome ascertainment and risk adjustment. Further, they wished to assess whether hospital rankings based on these measures changed following the addition of cancer-specific information derived from SEER cancer registries.
The researchers used Medicare claims data filed between 2005 and 2009 to calculate risk-adjusted cumulative mortality rates of patients with cancer at the hospital level. They conducted similar analyses using SEER databases to determine whether the inclusion of cancer-specific information — which is only available through cancer registries — in risk adjustments altered hospital performance.
Risk-adjusted OS and disease-specific survival, stratified by hospital type, served as the primary endpoint.
The analysis included data from 729,279 fee-for-service Medicare beneficiaries treated for cancer at hospitals treating 10 or more patients with each of the following cancers: lung, prostate, breast, colorectal and other. Researchers also evaluated a sample of 18,677 similar patients from the SEER–Medicare administrative database.
Bach and colleagues found large survival differences between different types of hospitals. At 1 year, patients treated by hospitals exempt from the Medicare prospective payment system (PPS–exempt) had a 10% lower mortality rate compared with community hospitals (18% vs. 28%), regardless of cancer type. This pattern persisted throughout 5 years of follow-up and within specific cancer categories.
Hospital performance ranking remained consistent with or without SEER–Medicare disease stage information (weighted ĸ ≥ 0.81).
The researchers acknowledged SEER–Medicare data may not be entirely representative of the general U.S. population.
“That there are very sizeable differences in outcomes between hospitals may explain why stage data seem not to be important — the actual differences are of much greater magnitude than small differences stage mix could explain,” Bach and colleagues wrote. “These large differences reinforce the conclusion drawn by the Institute of Medicine that the quality of cancer care in the U.S. is inconsistent and should be improved. To do so, we must first be able to observe, measure, and compare it both reliably and efficiently. The methodology we describe here provides a possible starting point.” – by Cameron Kelsall
Disclosure: Bach and all study researchers report employment at a PPS–exempt cancer hospital, Memorial Sloan Kettering Cancer Center. They report no other relevant financial disclosures.
Click Here to Manage Email Alerts