Study Shows VA Patients Have Fewer Potentially Avoidable Hospitalizations Post-Chemotherapy than Medicare Patients
BACKGROUND:
In recognition that many side effects of chemotherapy can be appropriately managed to avoid acute care utilization, the Centers for Medicare and Medicaid Services (CMS) released a new quality measure to reduce potentially avoidable hospital admissions among patients receiving outpatient chemotherapy. In this retrospective evaluation, investigators used this CMS measure to compare the quality of care received by chemotherapy patients treated through traditional Fee-for-Service (FFS) Medicare versus VA, using a cohort of dually-enrolled Veterans. Using VA and Medicare data, investigators identified 27,433 Veterans aged 66 and older who died from cancer between FY2010 and FY2014 – and who had received chemotherapy through Medicare (17,921 Veterans or 65% of cohort) or VA (9,522 Veterans or 35% of cohort). Cause of death was determined using National Death Index data. To properly compare VA and Medicare data, investigators adjusted the CMS measure (i.e., comparing observed outcomes in VA vs Medicare rather than rates for individual hospitals, and excluding comorbidities due to an imbalance in data capture for Medicare vs VA).
FINDINGS:
- Veterans with cancer receiving chemotherapy through VA have higher-quality care with respect to avoidable hospitalizations than Veterans receiving chemotherapy through Medicare. Roughly 7% of Veterans treated through Medicare had potentially avoidable hospitalizations in the 30 days following chemotherapy compared with approximately 5% of Veterans treated by VA.
- There were 1,715 patients with avoidable hospitalizations (6%). In the entire cohort, the top reasons for an avoidable hospitalization were pneumonia (41%), sepsis (24%), anemia (21%), and pain (11%), though the order of frequency changed when evaluating Medicare versus VA treatment.
IMPLICATIONS:
- This study was driven by recent legislation (Choice Act of 2014, MISSION Act of 2018) allowing Veterans to seek care in the private sector if VA care is difficult to access. As these policy changes are implemented, it is critical to understand whether this shift in system of care will impact care quality, especially for conditions as serious as cancer. These results indicate Veterans with cancer receive higher-quality care in VA than in fee-for-service settings with respect to avoidable hospitalizations post-chemotherapy, suggesting policymakers should monitor implications in quality of care external to VA.
LIMITATIONS:
- Veterans were not randomly assigned to a healthcare system; therefore, there may be unmeasured differences in the kinds of Veterans who seek care in VA versus Medicare that also affect the likelihood of potentially avoidable hospitalizations. Authors adjusted for variables previously shown to influence use of VA versus Medicare, but some selection bias may remain. The study also did not differentiate whether outcomes differed by form of Medicare payment (traditional FFS vs. Medicare Advantage).
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D. Dr. Gidwani-Marszowski is part of HSR&D’s Health Economics Resource Center (HERC), and Drs. Asch and Gidwani-Marszowksi are with HSR&D’s Center for Innovation to Implementation (Ci2i).
Gidwani-Marszowski R, Faricy-Anderson K, Asch S, et al. Potentially Avoidable Hospitalizations after Chemotherapy: Differences across Medicare and the Veterans Health Administration. Cancer. July 15, 2020;126(14):3297-3302.
