A study published in the American Journal of Managed Care (AJMC) found Medicare Advantage enrollees, particularly those with lower out-of-network (OON) benefits, may have restricted access to top-ranked hospitals for complex cancer care compared with traditional Medicare enrollees.
The study, to compare the use of top-ranked cancer hospitals for complex cancer surgery between Medicare Advantage (MA) and traditional Medicare fee-for-service (FFS) enrollees, used Medicare Provider Analysis and Review files. These files were used to compare differences in use of top-ranked cancer hospitals for complex cancer surgery (lobectomy, esophagectomy, gastrectomy, colectomy, and the Whipple procedure [pancreaticoduodenectomy]) between MA and FFS enrollees 65 years and older who underwent the surgery in 2015 to 2017.
The study found MA enrollees were less likely to use top-ranked cancer hospitals for complex cancer surgery than FFS enrollees. This difference was larger for MA plans with more restrictive OON policies. These findings suggest that MA enrollees, particularly those with lower OON benefits, may have restricted access to top-ranked hospitals for cancer care compared with FFS enrollees.
- Comparison of the Use of Top-Ranked Cancer Hospitals Between Medicare Advantage and Traditional Medicare. American Journal of Managed Care. October 2021