Potentially avoidable hospitalizations after chemotherapy: Differences across medicare and the Veterans Health Administration

다국어 초록 (Multilingual Abstract)

The Centers for Medicare and Medicaid Services (CMS) has released quality measures regarding potentially avoidable hospitalizations visits in the 30 days after receipt of outpatient chemotherapy. This study evaluated the proportions of patients treated by Medicare‐reimbursed clinicians and Veterans Health Administration (VA) clinicians who experienced avoidable acute care in order to evaluate differences in health system performance.
This retrospective evaluation of Medicare and VA administrative data used a cohort of cancer decedents (fiscal years 2010‐2014). Cohort members were veterans aged 66 years or older at death who were dually enrolled in Medicare and the VA. Chemotherapy was identified through International Classification of Diseases, Ninth Revision and Current Procedural Terminology (ICD-9) codes. CMS defines avoidable hospitalizations as those related to anemia, dehydration, diarrhea, emesis, fever, nausea, neutropenia, pain, pneumonia, or sepsis in the 30 days after chemotherapy. Following CMS guidance, this study compared the proportions of patients with potentially avoidable hospitalizations, using hierarchical generalized estimating equations.
There were 27,443 patients who received outpatient chemotherapy. Patients receiving Medicare chemotherapy were significantly more likely to have potentially avoidable hospitalizations than patients receiving VA chemotherapy (adjusted odds ratio, 1.58; 95% confidence interval, 1.41‐1.78; P < .001). In predicted estimates, 7.1% of Medicare‐treated veterans had potentially avoidable hospitalizations in the 30 days after chemotherapy, compared with 4.6% of VA‐treated veterans.
Results indicate veterans with cancer receiving chemotherapy in the VA have higher quality care with respect to avoidable hospitalizations than veterans receiving chemotherapy through Medicare. As more veterans seek care in the private sector under the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act, concerted efforts may be warranted to ensure that veterans do not experience a decline in care quality.
Using measure guidance from the Centers for Medicare and Medicaid Services, this study found patients receiving chemotherapy through Medicare are significantly more likely to experience potentially avoidable hospitalizations in the 30 days after chemotherapy compared to patients receiving chemotherapy in the Veterans Health Administration (VA). Results indicate that veterans with cancer receive higher quality care in the VA; therefore, policymakers must take proactive steps to ensure that quality of care does not suffer as the VA expands veteran access to care in the private sector.