Differences in risk-adjusted survival outcomes between hospitals affiliated with PPS-exempt cancer centers and others.

236 Background: Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020, or nearly one in six deaths. Selection of hospitals plays a key role in survival for a patient with cancer. Receiving complex cancer treatment from an insufficiently prepared hospital (eg, adequate experience, specialty trained surgeons) can expose a patient to a 4-fold increase in risk of death from surgical complications. Methods: Medicare claims data covering 2016-2019 was used to study risk-adjusted cumulative mortality rates of patients attributed to prospective payment system (PPS) exempt hospitals, hospitals affiliated with National Cancer Institute–designated cancer centers (NCI-CCs), Academic Medical Centers (AMCs) and Other US cancer hospitals. Cohort selection was based on using inpatient, outpatient, physician, DME claims with patient index date designated as the first cancer treatment date in 2016 with no prior year cancer diagnosis. Eligible patients had continuous enrollment for Medicare Parts A and B and no HMO. Attribution of patients to providers was based on plurality of services. We also applied CMS Hierarchical Conditioning Category (HCC) algorithms to calculate patient HCC risk score based on all diagnosis claims. Data came from 564,847 fee-for-service Medicare beneficiaries treated for cancer in 2016 at hospitals treating 10 or more patients. Demographic characteristics revealed PPS-exempt hospitals had higher proportion of metastatic site diseases and patients with higher median HCC risk scores compared to other hospitals. Cox proportional hazards regression was performed to assess overall survival between primary cancer treatment hospitals. The model was adjusted for age, race, gender, primary cancer and HCC risk scores. Results: Large survival differences were noticed between the treatment hospitals. 4-year survival estimates for PPS-exempt hospitals were 11% higher than NCI-CCs, 19% higher than AMCs and 25% higher than those treated at other medical centers. Conclusions: Our claims study suggests that short- and long-term survival for cancer patients was superior at PPS-exempt hospitals compared to other types of hospitals, adjusting for case-mix. The differences underpin the statement by the Institute of Medicine that the quality of cancer care in the United States is inconsistent and should be improved. Further study could reveal collaborative opportunities between hospitals to improve survival across the broader US population.