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Healthcare insurers paid about $4,000 to $6,000 more per cancer surgery case at a National Cancer Institute (NCI)-designated center than at community hospitals, despite no difference in resource use, a retrospective claims analysis showed.

Surgery-specific prices averaged $18,526 at NCI centers versus $14,772 at community hospitals, and 90-day postdischarge payments were $47,035 and $41,291, respectively. Non-NCI academic centers also had higher prices as compared with community hospitals, but they were lower than the NCI centers.

Length of hospitalization, emergency department visits, and 90-day hospital readmission rates did not differ among the groups, reported Samuel U. Takvorian, MD, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and co-authors in .

"Facility rather than physician payments accounted for most of the difference in spending outcomes, consistent with national trends showing that hospital payments occupy a disproportionate and growing share of overall healthcare spending," the authors wrote. "These results support our hypothesis that insurer spending would be higher at NCI centers than community hospitals, possibly due to their size, market share, and prestige, affording leverage in negotiations with private payers."

"However, contrary to our hypothesis, there were comparable rates of postdischarge acute care utilization across hospital types, suggesting that negotiated transaction prices, rather than utilization, may be driving site-level differences in spending. ... While acceptable to pay higher prices for care that is expected to be of higher quality, we found no differences in short-term postsurgical outcomes ... by hospital type, which is consistent with results from a comparing postsurgical outcomes for Medicare patients across varying types of cancer hospitals."

The author of an agreed that the price differences appeared to be "driven by higher prices negotiated by these cancer centers with commercial payers." Similar findings emerged from a of health plan spending at NCI-designated centers versus other hospitals for privately insured young adults with acute lymphoblastic leukemia.

"Some evidence suggests that care at NCI-designated cancer center hospitals is associated with than care in community hospitals," wrote Nancy L. Keating, MD, MPH, of Brigham and Women's Hospital and Harvard Medical School in Boston. "Improved outcomes at NCI-designated cancer centers may be particularly evident for patients undergoing cancer-related surgical procedures, for which higher patient volumes may also have benefits."

"It is likely that some patients benefit from the highly specialized care available at NCI-designated cancer centers, particularly patients with rarer or complex clinical conditions, patients requiring complex procedures, or those for whom clinical trials may offer promising treatment options. But it is also likely that many other patients will do equally well regardless of where they receive their care," she continued.

More research is needed to understand prices and to measure the quality of care that patients receive across hospitals and practices, she added. "Such information is critical to assess the extent to which payers and patients achieve value for healthcare dollars spent at NCI-designated cancer centers and to identify subgroups of patients for whom highly specialized care is particularly necessary to achieve better outcomes."

Takvorian and co-authors reported findings from an analysis of 66,878 patients who underwent cancer surgery from 2011 to 2014, identified from the national multipayer commercial claims dataset. The analysis was limited to patients who had surgery for breast (53.5%), colon (32.0%), or lung (14.5%) cancer. Almost half (47.2%) of the patients were 65 or older, and women accounted for 77.1% of the study population.

The patients had surgery at 2,995 hospitals: 75.4% (50,439) at community hospitals, 8.3% (5,522) at NCI centers, and 16.3% (10,917) at non-NCI academic centers.

NCI-designated centers charged an average of $3,755 more for surgery-specific services as compared with the community hospitals (P<0.001). Most of the difference was attributable to facility costs ($3,584, P<0.001). Prices at non-NCI academic centers averaged $15,394 (P=0.01 vs community hospitals), and most of the $1,359 difference resulted from higher facility prices ($1,274, P=0.02).

The price for 90-day postdischarge care was $5,744 more at NCI centers (P=0.006) and $1,484 higher at non-NCI academic centers (P=0.20). The price for outpatient care was significantly higher at NCI centers ($2,778, P=0.02) and non-NCI academic centers ($1,322, P=0.03). Physician costs were higher at community hospitals. Inpatient and pharmacy costs did not differ among the three types of facilities.

As for study limitations, the authors acknowledged that the study was restricted to three types of cancer, there was no analysis of out-of-pocket spending, they were unable to adjust for certain clinical factors that could have influenced findings, and there were potential unmeasured factors.

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