Potentially avoidable hospitalizations after chemotherapy: Differences across medicare and the Veterans Health Administration
Background 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 an...
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| Veröffentlicht in: | Cancer 2020-07, Vol.126 (14), p.3297-3302 |
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| creator | Gidwani‐Marszowski, Risha Faricy‐Anderson, Katherine Asch, Steven M. Illarmo, Samantha Ananth, Lakshmi Patel, Manali I. |
| description | Background
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.
Methods
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.
Results
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 |
| doi_str_mv | 10.1002/cncr.32896 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8370719</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2416867983</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4486-603c7fd124fe260adb1df0a2a2a83b2a00bf809e19d19186a93dc7c3687e14083</originalsourceid><addsrcrecordid>eNp9kU2LFDEQhoMo7rh68QdIwIsIvVY-tjvtYWEZP1ZYVETFW6hOV9tZMp0x6VkZwf9udmZd1IPkEEI9eaiql7GHAo4EgHzmJpeOlDRtfYstBLRNBULL22wBAKY61urLAbuX80V5NvJY3WUHSmoQSsOC_XwfZ5pmjyFsOV5G32MXiI8xr_2Mwf_A2ccpcxxmStyNtIrzSAnX2-f8hR8GSjQ5KnWXYs58Rb13mIjj1PMC8s9U_mERnBGGeeSn_cpPPs9p573P7gwYMj24vg_Zp1cvPy7PqvN3r98sT88rp7WpqxqUa4ZeSD2QrAH7TvQDoCzHqE4iQDcYaEm0vWiFqbFVvWucqk1DQoNRh-xk711vutKiKxMnDHad_ArT1kb09u_K5Ef7NV5aoxpoRFsET64FKX7bUJ7tymdHIeBEcZNt2afUGpSsC_r4H_QibtJUxiuUqE3dtEYV6ume2u0t0XDTjAB7laq9StXuUi3woz_bv0F_x1gAsQe--0Db_6js8u3yw176C1RasHQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2416867983</pqid></control><display><type>article</type><title>Potentially avoidable hospitalizations after chemotherapy: Differences across medicare and the Veterans Health Administration</title><source>Wiley Online Library</source><source>Wiley Online Library Journals Frontfile Complete</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Gidwani‐Marszowski, Risha ; Faricy‐Anderson, Katherine ; Asch, Steven M. ; Illarmo, Samantha ; Ananth, Lakshmi ; Patel, Manali I.</creator><creatorcontrib>Gidwani‐Marszowski, Risha ; Faricy‐Anderson, Katherine ; Asch, Steven M. ; Illarmo, Samantha ; Ananth, Lakshmi ; Patel, Manali I.</creatorcontrib><description>Background
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.
Methods
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.
Results
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.
Conclusions
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.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.32896</identifier><identifier>PMID: 32401340</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Anemia ; Cancer ; Chemotherapy ; Confidence intervals ; Dehydration ; Diarrhea ; Fever ; Government programs ; Hospitalization ; Medicare ; Nausea ; Neutropenia ; Oncology ; Pain ; Performance evaluation ; Private sector ; quality of health care ; Sepsis ; Terminology ; veterans ; Vomiting</subject><ispartof>Cancer, 2020-07, Vol.126 (14), p.3297-3302</ispartof><rights>2020 American Cancer Society</rights><rights>2020 American Cancer Society.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4486-603c7fd124fe260adb1df0a2a2a83b2a00bf809e19d19186a93dc7c3687e14083</citedby><cites>FETCH-LOGICAL-c4486-603c7fd124fe260adb1df0a2a2a83b2a00bf809e19d19186a93dc7c3687e14083</cites><orcidid>0000-0002-3548-2332 ; 0000-0002-9943-5762</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncr.32896$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncr.32896$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32401340$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gidwani‐Marszowski, Risha</creatorcontrib><creatorcontrib>Faricy‐Anderson, Katherine</creatorcontrib><creatorcontrib>Asch, Steven M.</creatorcontrib><creatorcontrib>Illarmo, Samantha</creatorcontrib><creatorcontrib>Ananth, Lakshmi</creatorcontrib><creatorcontrib>Patel, Manali I.</creatorcontrib><title>Potentially avoidable hospitalizations after chemotherapy: Differences across medicare and the Veterans Health Administration</title><title>Cancer</title><addtitle>Cancer</addtitle><description>Background
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.
Methods
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.
Results
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.
Conclusions
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.</description><subject>Anemia</subject><subject>Cancer</subject><subject>Chemotherapy</subject><subject>Confidence intervals</subject><subject>Dehydration</subject><subject>Diarrhea</subject><subject>Fever</subject><subject>Government programs</subject><subject>Hospitalization</subject><subject>Medicare</subject><subject>Nausea</subject><subject>Neutropenia</subject><subject>Oncology</subject><subject>Pain</subject><subject>Performance evaluation</subject><subject>Private sector</subject><subject>quality of health care</subject><subject>Sepsis</subject><subject>Terminology</subject><subject>veterans</subject><subject>Vomiting</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kU2LFDEQhoMo7rh68QdIwIsIvVY-tjvtYWEZP1ZYVETFW6hOV9tZMp0x6VkZwf9udmZd1IPkEEI9eaiql7GHAo4EgHzmJpeOlDRtfYstBLRNBULL22wBAKY61urLAbuX80V5NvJY3WUHSmoQSsOC_XwfZ5pmjyFsOV5G32MXiI8xr_2Mwf_A2ccpcxxmStyNtIrzSAnX2-f8hR8GSjQ5KnWXYs58Rb13mIjj1PMC8s9U_mERnBGGeeSn_cpPPs9p573P7gwYMj24vg_Zp1cvPy7PqvN3r98sT88rp7WpqxqUa4ZeSD2QrAH7TvQDoCzHqE4iQDcYaEm0vWiFqbFVvWucqk1DQoNRh-xk711vutKiKxMnDHad_ArT1kb09u_K5Ef7NV5aoxpoRFsET64FKX7bUJ7tymdHIeBEcZNt2afUGpSsC_r4H_QibtJUxiuUqE3dtEYV6ume2u0t0XDTjAB7laq9StXuUi3woz_bv0F_x1gAsQe--0Db_6js8u3yw176C1RasHQ</recordid><startdate>20200715</startdate><enddate>20200715</enddate><creator>Gidwani‐Marszowski, Risha</creator><creator>Faricy‐Anderson, Katherine</creator><creator>Asch, Steven M.</creator><creator>Illarmo, Samantha</creator><creator>Ananth, Lakshmi</creator><creator>Patel, Manali I.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3548-2332</orcidid><orcidid>https://orcid.org/0000-0002-9943-5762</orcidid></search><sort><creationdate>20200715</creationdate><title>Potentially avoidable hospitalizations after chemotherapy: Differences across medicare and the Veterans Health Administration</title><author>Gidwani‐Marszowski, Risha ; Faricy‐Anderson, Katherine ; Asch, Steven M. ; Illarmo, Samantha ; Ananth, Lakshmi ; Patel, Manali I.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4486-603c7fd124fe260adb1df0a2a2a83b2a00bf809e19d19186a93dc7c3687e14083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anemia</topic><topic>Cancer</topic><topic>Chemotherapy</topic><topic>Confidence intervals</topic><topic>Dehydration</topic><topic>Diarrhea</topic><topic>Fever</topic><topic>Government programs</topic><topic>Hospitalization</topic><topic>Medicare</topic><topic>Nausea</topic><topic>Neutropenia</topic><topic>Oncology</topic><topic>Pain</topic><topic>Performance evaluation</topic><topic>Private sector</topic><topic>quality of health care</topic><topic>Sepsis</topic><topic>Terminology</topic><topic>veterans</topic><topic>Vomiting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gidwani‐Marszowski, Risha</creatorcontrib><creatorcontrib>Faricy‐Anderson, Katherine</creatorcontrib><creatorcontrib>Asch, Steven M.</creatorcontrib><creatorcontrib>Illarmo, Samantha</creatorcontrib><creatorcontrib>Ananth, Lakshmi</creatorcontrib><creatorcontrib>Patel, Manali I.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gidwani‐Marszowski, Risha</au><au>Faricy‐Anderson, Katherine</au><au>Asch, Steven M.</au><au>Illarmo, Samantha</au><au>Ananth, Lakshmi</au><au>Patel, Manali I.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Potentially avoidable hospitalizations after chemotherapy: Differences across medicare and the Veterans Health Administration</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>2020-07-15</date><risdate>2020</risdate><volume>126</volume><issue>14</issue><spage>3297</spage><epage>3302</epage><pages>3297-3302</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><abstract>Background
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.
Methods
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.
Results
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.
Conclusions
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.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32401340</pmid><doi>10.1002/cncr.32896</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-3548-2332</orcidid><orcidid>https://orcid.org/0000-0002-9943-5762</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Online Library; Wiley Online Library Journals Frontfile Complete; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Anemia Cancer Chemotherapy Confidence intervals Dehydration Diarrhea Fever Government programs Hospitalization Medicare Nausea Neutropenia Oncology Pain Performance evaluation Private sector quality of health care Sepsis Terminology veterans Vomiting |
| title | Potentially avoidable hospitalizations after chemotherapy: Differences across medicare and the Veterans Health Administration |
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