Association of hospital type with prices, spending, and acute care utilization among privately insured patients undergoing cancer surgery.

Abstract

e19376 Background: With annual cancer spending estimated to surpass $170 billion in 2020, national attention has focused on the prices and utilization of cancer care. This is particularly important for privately insured patients, for whom healthcare prices are negotiated between insurers and providers and price transparency is lacking. Among privately insured patients undergoing common cancer surgery, we examined the relation between hospital type and prices, spending, and utilization. Methods: We conducted a retrospective study using Health Care Cost Institute’s multipayer national commercial claims data. The study population included patients with breast, colon or lung cancer undergoing cancer surgery from 2011-2014. The exposure was hospital type at which surgery was performed: National Cancer Institute (NCI), academic, or community. Spending outcomes were surgery-specific prices paid and 90-day total episode spending. Utilization outcomes were length of stay (LOS), emergency department (ED) use, and hospital readmission within 90 days. We estimated mean risk-adjusted spending and utilization outcomes for each hospital type using generalized linear mixed-effects models, adjusting for patient, hospital and region characteristics. Results: We identified 66,878 patients with incident breast (53.5%), colon (32.0%), or lung (14.5%) cancer undergoing cancer surgery at 2,995 hospitals (8.3% at NCI; 16.3% academic; 75.4% community). Treatment at NCI cancer centers was associated with higher surgical prices paid ($18,310 at NCI v $14,703 at community hospitals; diff +$3,607; p < 0.001) and 90-day total episode spending ($46,462 v $41,274; diff +$5,188; p = 0.008). There were no significant differences in LOS, ED use or hospital readmission within 90 days. Conclusions: Among privately insured patients undergoing cancer surgery, NCI cancer centers had higher surgical prices and episode spending without differences in utilization, compared to community hospitals. A better understanding of the drivers of prices and spending at NCI cancer centers is needed. [Table: see text]