Hospitalization a Major Burden on Medicare Beneficiaries With Cancer

A nationally representative study among patients enrolled in Medicare, who were diagnosed with cancer, found that out-of-pocket (OOP) costs averaged at 23.7% of their household income. More significantly, 10% of patients incurred costs that were a little over 63% of their total family income.

The authors of this JAMA Oncology study collected survey data from 18,166 Medicare enrollees, 1409 of whom were diagnosed with cancer during the study period marked between January 1, 2002, and December 31, 2012. The primary outcome being evaluated was OOP costs and financial burden (OOP expenditure divided by the household income).

With a fairly even distribution of males and females, supplementary insurance showed a strong association with the mean annual OOP costs following a cancer diagnosis, among the 1409 individuals. Specifically, the following costs were documented:

• $2116 among Medicaid insured
• $2367 among those insured by the Veteran’s Health Administration
• $5976 among those insured by Medicare
• $5492 among those on employer-sponsored insurance
• $5670 among those on Medigap insurance
• $8115 among those on fee-for-service Medicare and without any supplemental coverage

A new cancer diagnosis was also associated with greater odds of higher OOP costs, the authors found (adjusted odds ratio, 1.86; 95% CI, 1.55-2.23; P&thinsp;<&thinsp;.001). The 10% of patients with cancer who had the highest OOP costs found hospitalization a major drain on their wallet, accounting for 41.6% of their overall OOP expenditure.

Based on their findings, the authors propose a Medicare benefit redesign for hospital-based services, in addition to a cap on maximum OOP costs for Medicare beneficiaries. Additionally, they also recommend interventions that can reduce hospitalizations among these individuals.

The community-based medical home model has always been a strong proponent of keeping patients out of the hospital. Using an in-house triage system and a triage nurse to help direct patient calls and even provide 27/7 medical advice, Barbara McAneny, MD, chief executive officer, New Mexico Cancer Center & Innovative Oncology Business Solutions, has developed the COME HOME model for oncology care, all in an effort to render patient-centered care while keeping costs down.

“We have to be able to manage the patients, have to ensure that they get what they need, and we need to have an adequate system in place to support the process. This will help keep patients out of the hospital and to keep the costs low,” McAneny said at The Community Oncology Conference: Innovation in Cancer Care, earlier this year.