Medicaid linked to worse colon cancer outcomes

By Will Boggs, MD

NEW YORK (Reuters Health) - The risk of death following surgery for colon cancer is higher at hospitals with a high percentage of Medicaid patients, according to a report in the Journal of the American College of Surgeons.

The report "emphasizes the potential effect of resource inequality across institutions on cancer outcomes (and) highlights the potential issues facing 'high Medicaid' hospitals as American healthcare economies tighten and pay-for-performance emerges as a major determinant of healthcare quality," Dr. Kim F. Rhoads told Reuters Health.

"Policy-makers creating these programs need to remain vigilant in the recognition that financial penalties levied against economically disadvantaged institutions may worsen, not improve outcomes," she added.

Rhoads from Stanford University, California, and colleagues assessed the outcomes of colon cancer patients treated at hospitals with a high proportion (greater than 40 percent) of Medicaid patients, compared with other hospitals.

Compared with patients treated at other hospitals, those treated at high Medicaid had a higher risk of death at 30 days and 1 year after surgery, the investigators found.

After accounting for the number of operations performed at each hospital, however, the difference at 30 days was no longer considered significant from a statistical standpoint. The 1-year risk of death for patients treated at high Medicaid hospitals was fairly low, at 3.4 percent.

The detrimental effect of treatment at a high Medicaid hospital had disappeared by 5 years after treatment, the report indicates. However, the 5-year death rate was higher among patients with Medicaid than among patients with private insurance regardless of where they were treated.

Rhoads offered several suggestions for reducing the disparities: "At the physician level, we need to build stronger networks between primary providers and the various specialists involved in cancer care, from diagnosis to treatment and surveillance."

At the hospital level, "cancer navigator roles (where they exist) might be extended to act as cancer case managers to help patients get through a complex system of cancer management; and avoid getting lost in the shuffle," Rhoads suggested.

"At the system level, I would advocate for specific structuring of incentive-based quality improvement programs such as public reporting and pay-for-performance to support and enhance communications between interdisciplinary providers," she added.

SOURCE: Journal of the American College of Surgeons, August 2008.