• Daeho Kim, David J Meyers, Momotazur Rahman, and Amal N Trivedi.
• Department of Health Services, Policy, and Practice, Brown University, 121 S Main St, Providence, RI 02903. Email: Daeho_Kim@brown.edu.
• Am J Manag Care. 2021 Oct 1; 27 (10): e355-e360.

ObjectivesTo compare the use of top-ranked cancer hospitals for complex cancer surgery between Medicare Advantage (MA) and traditional Medicare fee-for-service (FFS) enrollees.Study DesignCross-sectional analysis of Medicare claims and enrollment data.MethodsThe study used Medicare Provider Analysis and Review files to compare differences in use of top-ranked cancer hospitals for complex cancer surgery (lobectomy, esophagectomy, gastrectomy, colectomy, and the Whipple procedure [pancreaticoduodenectomy]) between MA and FFS enrollees 65 years and older who underwent the surgery in 2015 to 2017.ResultsAfter adjusting for demographic characteristics and county fixed effects, MA enrollees were less likely to use top-ranked cancer hospitals than FFS enrollees by 6.0 percentage points (95% CI, 4.7-7.2) overall; the difference varied from 3.5 percentage points (95% CI, 2.5-4.6) for colectomy to 14.3 percentage points (95% CI, 10.9-17.8) for the Whipple procedure. The difference in cancer surgery rate at a top-ranked cancer hospital between MA and FFS enrollees was larger for MA plans without out-of-network (OON) benefits (-7.5 percentage points; 95% CI, -9.1 to -5.9) than for MA plans with OON benefits (-2.3 percentage points; 95% CI, -2.9 to -1.7).ConclusionsMA enrollees were less likely to use top-ranked cancer hospitals for complex cancer surgery than FFS enrollees. This difference was larger for MA plans with more restrictive OON policies. These findings suggest that MA enrollees, particularly those with lower OON benefits, may have restricted access to top-ranked hospitals for cancer care compared with FFS enrollees.

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