They’re old enough to qualify for Medicare, and their incomes are low enough to qualify them for Medicaid. However, recent research has found that when these “dual eligible” patients have surgery to remove a cancerous tumor, they suffer more complications, stay in the hospital longer, and have a lower chance of going home instead of a nursing facility than patients with Medicare alone—even when they go to a hospital with low complication rates for their procedure. These findings were published by Taylor et al in JAMA Surgery.
The findings suggest that hospitals should be doing more to assess and support the needs of such dual-eligible patients before, during, and after their operations to improve equity and reduce preventable costs. Past research has shown that dual-eligible patients account for a disproportionate share of federal health-care spending, totaling $300 billion in 2018 alone. This new study focused on the outcomes of patients who had surgery for four types of cancer.
“We found that although outcomes and spending are improved for dual-eligible patients at the highest-quality hospitals, inequities persist, and improving quality alone will not fully close this gap,” said first study author Kathryn Taylor, MD, a National Clinician Scholar at the University of Michigan Institute for Healthcare Policy and Innovation, member of the University of Michigan Center for Healthcare Outcomes and Policy, as well as a surgical resident at Stanford University. “Given that we know dual eligibility is an indicator of social risk, interventions targeted to unmet social health needs are likely needed to improve outcomes in this population, such as screening and connecting to resources for food insecurity, housing instability, and transportation.”
Study Details
The study used data from nearly 120,000 older adults who had cancer surgery for lung, colon, pancreatic, or rectal cancers between 2014 and 2018; 11% had dual eligibility for both public insurance programs. These patients were less likely to have their surgery at a hospital that the researchers deemed “high quality” for that operation, meaning that complication rates for all patients having that procedure were in the lowest fifth overall.
Across the board, dual-eligible patients had more complications, longer length of hospital stay, a higher chance of being discharged to a nursing facility, and higher costs for the total episode of their care, with average differences of more than $2,000. These differences decreased—but did not disappear—when the researchers focused on the dual-eligible patients who had their surgery at high-quality hospitals.
That suggests, said Dr. Taylor, that ongoing quality improvement programs for all types of hospitals are important. But the persistence of outcome and cost disparities between dual-eligible and traditional Medicare patients treated at high-quality hospitals suggests more needs to be done even at such facilities.
In an accompanying invited commentary, a team from Northwestern University said that “Medicare and Medicaid must continue to test novel care delivery models that better serve dual-eligible patients, and society must invest in robust upstream solutions for social determinants of health.”
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
