Insurance type impacts the economic burden and survival of patients with newly diagnosed glioblastoma

2020 ◽  
Vol 133 (1) ◽  
pp. 89-99
Author(s):  
Ankush Chandra ◽  
Jacob S. Young ◽  
Cecilia Dalle Ore ◽  
Fara Dayani ◽  
Darryl Lau ◽  
...  
Keyword(s):  
Economic Burden ◽  
Private Insurance ◽  
Hospital Costs ◽  
Primary Care Providers ◽  
Tumor Diameter ◽  
Inpatient Hospital ◽  
Lengths Of Stay ◽  
Insured Patients ◽  
The Impact ◽  
Privately Insured

OBJECTIVEGlioblastoma (GBM) carries a high economic burden for patients and caregivers, much of which is associated with initial surgery. The authors investigated the impact of insurance status on the inpatient hospital costs of surgery for patients with GBM.METHODSThe authors conducted a retrospective review of patients with GBM (2010–2015) undergoing their first resection at the University of California, San Francisco, and corresponding inpatient hospital costs.RESULTSOf 227 patients with GBM (median age 62 years, 37.9% females), 31 (13.7%) had Medicaid, 94 (41.4%) had Medicare, and 102 (44.9%) had private insurance. Medicaid patients had 30% higher overall hospital costs for surgery compared to non-Medicaid patients ($50,285 vs $38,779, p = 0.01). Medicaid patients had higher intensive care unit (ICU; p < 0.01), operating room (p < 0.03), imaging (p < 0.001), room and board (p < 0001), and pharmacy (p < 0.02) costs versus non-Medicaid patients. Medicaid patients had significantly longer overall and ICU lengths of stay (6.9 and 2.6 days) versus Medicare (4.0 and 1.5 days) and privately insured patients (3.9 and 1.8 days, p < 0.01). Medicaid patients had similar comorbidity rates to Medicare patients (67.8% vs 68.1%), and both groups had higher comorbidity rates than privately insured patients (37.3%, p < 0.0001). Only 67.7% of Medicaid patients had primary care providers (PCPs) versus 91.5% of Medicare and 86.3% of privately insured patients (p = 0.009) at the time of presentation. Tumor diameter at diagnosis was largest for Medicaid (4.7 cm) versus Medicare (4.1 cm) and privately insured patients (4.2 cm, p = 0.03). Preoperative (70 vs 90, p = 0.02) and postoperative (80 vs 90, p = 0.03) Karnofsky Performance Scale (KPS) scores were lowest for Medicaid versus non-Medicaid patients, while in subgroup analysis, postoperative KPS score was lowest for Medicaid patients (80, vs 90 for Medicare and 90 for private insurance; p = 0.03). Medicaid patients had significantly shorter median overall survival (10.7 months vs 12.8 months for Medicare and 15.8 months for private insurance; p = 0.02). Quality-adjusted life year (QALY) scores were 0.66 and 1.05 for Medicaid and non-Medicaid patients, respectively (p = 0.036). The incremental cost per QALY was $29,963 lower for the non-Medicaid cohort.CONCLUSIONSPatients with GBMs and Medicaid have higher surgical costs, longer lengths of stay, poorer survival, and lower QALY scores. This study indicates that these patients lack PCPs, have more comorbidities, and present later in the disease course with larger tumors; these factors may drive the poorer postoperative function and greater consumption of hospital resources that were identified. Given limited resources and rising healthcare costs, factors such as access to PCPs, equitable adjuvant therapy, and early screening/diagnosis of disease need to be improved in order to improve prognosis and reduce hospital costs for patients with GBM.

scholarly journals Impact of Health Insurance Expansion on the Treatment of Colorectal Cancer

2016 ◽  
Vol 34 (34) ◽  
pp. 4110-4115 ◽  
Author(s):  
Andrew P. Loehrer ◽  
Zirui Song ◽  
Alex B. Haynes ◽  
David C. Chang ◽  
Matthew M. Hutter ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health Care Reform ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The United States ◽  
The Third ◽  
Insured Patients ◽  
The Impact ◽  
Privately Insured

Purpose Colorectal cancer is the third most common cancer and the third leading cause of cancer deaths in the United States. Lack of insurance coverage has been associated with more advanced disease at presentation, more emergent admissions at time of colectomy, and lower survival relative to privately insured patients. The 2006 Massachusetts health care reform serves as a unique natural experiment to assess the impact of insurance expansion on colorectal cancer care. Methods We used the Hospital Cost and Utilization Project State Inpatient Databases to identify patients with colorectal cancer with government-subsidized or self-pay (GSSP) or private insurance admitted to a hospital between 2001 and 2011 in Massachusetts (n = 17,499) and three control states (n = 144,253). Difference-in-differences models assessed the impact of the 2006 Massachusetts coverage expansion on resection of colorectal cancer, controlling for confounding factors and secular trends. Results Before the 2006 Massachusetts reform, government-subsidized or self-pay patients had significantly lower rates of resection for colorectal cancer compared with privately insured patients in both Massachusetts and the control states. The Massachusetts insurance expansion was associated with a 44% increased rate of resection (rate ratio = 1.44; 95% CI, 1.23 to 1.68; P < .001), a 6.21 percentage point decreased probability of emergent admission (95% CI, −11.88 to −0.54; P = .032), and an 8.13 percentage point increased probability of an elective admission (95% CI, 1.34 to 14.91; P = .019) compared with the control states. Conclusion The 2006 Massachusetts health care reform, a model for the Affordable Care Act, was associated with increased rates of resection and decreased probability of emergent resection for colorectal cancer. Our findings suggest that insurance expansion may help improve access to care for patients with colorectal cancer.

scholarly journals Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis

2019 ◽  
Vol 56 ◽  
pp. 004695801983811 ◽  
Author(s):  
Walter R. Hsiang ◽  
Adam Lukasiewicz ◽  
Mark Gentry ◽  
Chang-Yeon Kim ◽  
Michael P. Leslie ◽  
...  
Keyword(s):  
Health Care ◽  
Meta Analysis ◽  
Private Insurance ◽  
Secondary Analysis ◽  
Physician Practices ◽  
Lower Likelihood ◽  
Different Types ◽  
Appointment Availability ◽  
Insured Patients ◽  
Privately Insured

Medicaid patients are known to have reduced access to care compared with privately insured patients; however, quantifying this disparity with large controlled studies remains a challenge. This meta-analysis evaluates the disparity in health services accessibility of appointments between Medicaid and privately insured patients through audit studies of health care appointments and schedules. Audit studies evaluating different types of outpatient physician practices were selected. Studies were categorized based on the characteristics of the simulated patient scenario. The relative risk of appointment availability was calculated for all different types of audit scenario characteristics. As a secondary analysis, appointment availability was compared pre- versus post-Medicaid expansion. Overall, 34 audit studies were identified, which demonstrated that Medicaid insurance is associated with a 1.6-fold lower likelihood in successfully scheduling a primary care appointment and a 3.3-fold lower likelihood in successfully scheduling a specialty appointment when compared with private insurance. In this first meta-analysis comparing appointment availability between Medicaid and privately insured patients, we demonstrate Medicaid patients have greater difficulty obtaining appointments compared with privately insured patients across a variety of medical scenarios.

Impact of insurance status on survival in neuroendocrine tumors: A multi-institutional Study from the U.S. Neuroendocrine Study Group.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 371-371
Author(s):  
Paula Marincola Smith ◽  
Alexandra G Lopez-Aguiar ◽  
Mary Dillhoff ◽  
Eliza W Beal ◽  
George A. Poultsides ◽  
...  
Keyword(s):  
Overall Survival ◽  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Private Insurance ◽  
The United States ◽  
Study Group ◽  
Insurance Status ◽  
Insured Patients ◽  
The Impact ◽  
The U.S

371 Background: Insurance status predicts access to medical care in the United States. Previous studies show uninsured and government insured patients have worse outcomes than those with private insurance. However, the impact of insurance status on survival in patients with Gastrointestinal Neuroendocrine Tumors (GI-NETs) is unclear. We evaluate the association between insurance status and survival in patients with GI-NETs. Methods: Our analysis includes 2022 patients who had surgical resection of GI-NETs at 8 institutions in the U.S. Neuroendocrine Study Group. Patients were categorized based on insurance as private (PI), government (GovI) or uninsured (UI). Factors associated with insurance status were assessed by uni- and multi-variate analysis. Primary endpoint was overall survival. Results: Patient demographics between the insurance categories were similar in ECOG performance status and tumor size at presentation. GovI patients had a higher median age than PI or UI (66 vs. 54 vs. 56 years respectively; p<0.01). Uninsured patients were more likely African American (21.5%) or Latino (5%) compared to PI (11.5%, 2%) or GovI (15%, 2%) (p<0.01). The UI group had a higher proportion of patients who underwent no surveillance imaging post-operatively (39%) compared to PI (26%) and GovI patients (26%) but this was not statistically significant (p=0.15). There was no difference in operative intent (curative vs. palliative) between groups (p=0.2). Five-year overall survival was 86% for PI, 82% for GovI, and 73% for UI patients (p<0.01). On multivariate regression analysis, being uninsured was independently associated with reduced survival when controlling for ASA Class, ECOG, race, tumor location, neoadjuvant and adjuvant chemotherapy, Somatostatin analog, or radiation therapy (HR 1.39, p = 0.012). Conclusions: This is the first systematic analysis of insurance status’s association with overall survival in GI-NET patients. Our analysis shows uninsured or government insured patients have shortened survival compared to the privately insured. The disparity is likely underrepresented in this study, as we examined only patients who underwent surgical resection.

Abstract P31: Medicare Reimbursement and Patterns of tPA Utilization for Acute Ischemic Stroke Patients

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Meg M Comins ◽  
Dawood H Sultan ◽  
Deanna J Wathington
Keyword(s):  
Systems Of Care ◽  
Private Insurance ◽  
Full Range ◽  
Stroke Care ◽  
Primary Data ◽  
Stroke Patients ◽  
Term Care ◽  
Lengths Of Stay ◽  
Stroke Systems Of Care ◽  
Insured Patients

Background. Tissue plasminogen activator (tPA) is recommended for stroke patients presenting within 3 hours of symptom onset. Patients treated with tPA have been shown to experience superior outcomes over other thrombolytics. Higher costs for tPA are said to be offset by savings from shorter lengths of stay and lower likelihoods of being discharged to rehabilitation or long-term care. Encouraged by the American Stroke Association (ASA), CMS created DRG 559 in FY 2006, increasing the reimbursement for stroke patients receiving tPA by an average of $6,700 to advance tPA utilization. In FY 2007, CMS replaced DRGs with severity-adjusted DRGs (MS-DRGs); three MS-DRGs replaced DRG 559, lowering the reimbursement rate for tPA treatment. The primary data source was the HCUP 2005-2007, Nationwide Inpatient Sample, a 20% sample of up to 700 hospitals per year in 27 states. Discharge records were analyzed for patients aged 45 and older, with a discharge diagnosis for cerebral infarction (ICD-9 codes 362.3, 433.x1, 434.x1, and acute, but ill-defined, cerebrovascular disease (ICD-9 code 436) and excluding secondary diagnoses of traumatic brain injury (codes 800-804, 850-854). Patients were stratified by age, payer, and DRGs 61, 62, 63 or 559 with a primary ICD-9 procedure code of 99.10. Results. From 2005 to 2006, tPA utilization increased 68.1%, but increased only 1.36% from 2006 to 2007. tPa uitilization increased for Medicare and Medicaid patients overall, but declined for privately insured patients from 2006 to 2007. Discussion. The Brain Attack Coalition endorses statewide stroke systems of care, including certification of comprehensive and primary stroke centers. Comprehensive centers must be capable of providing the full range of stroke care including tPA to patients. Seven states were developing, or had in place stroke systems of care in 2007. The decline in reimbursement may act as a disincentive to other states to create systems of care. Stroke patients with tPA as the primary procedure, number and percentage of tPa patients by row. 2005 (n=60,009) 2006 (n=57,298) 2007 (n=55,669) tPA Patients 789 (1.31) 1326 (2.32) 1344 (2.41) DRG 14 480 (60.84) - - DRG 559 306 (38.78) 1,317 (99.3) 977 (72.7) DRG 61 - - 96 (7.1) DRG 62 - - 170 (12.6) DRG 63 92 (6.8) Medicare 506 (1.15) 883 (2.16) 899 (2.3) Medicaid 32 (1.09) 58 (1.86) 67 (2.08) Private Insurance 213 (2.13) 309 (3.26) 296 (3.05)

scholarly journals Medicaid Health Insurance Status Limits Patient Accessibility to Rehabilitation Services Following ACL Reconstruction Surgery

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876335 ◽  
Author(s):  
Miranda J. Rogers ◽  
Ian Penvose ◽  
Emily J. Curry ◽  
Anthony DeGiacomo ◽  
Xinning Li
Keyword(s):  
Health Insurance ◽  
Acl Reconstruction ◽  
Metropolitan Area ◽  
Private Insurance ◽  
The United States ◽  
The State ◽  
Median Income ◽  
Insurance Type ◽  
Insured Patients ◽  
Privately Insured

Background: In the senior author’s (X.L.) orthopaedic sports medicine clinic in the United States (US), patients appear to have difficulty finding physical therapy (PT) practices that accept Medicaid insurance for postoperative rehabilitation. Purpose: To determine access to PT services for privately insured patients versus those with Medicaid who underwent anterior cruciate ligament (ACL) reconstruction in the largest metropolitan area in the state of Massachusetts, which underwent Medicaid expansion as part of the Affordable Care Act. Study Design: Cross-sectional study. Methods: Locations offering PT services were identified through Google, Yelp, and Yellow Pages internet searches. Each practice was contacted and queried about health insurance type accepted (Medicaid [public] vs Blue Cross Blue Shield [private]) for postoperative ACL reconstruction rehabilitation. Additional data collection points included time to first appointment, reason for not accepting insurance, and ability to refer to a location accepting insurance type. Median income and percentage of households living in poverty were also noted through US Census data for the town in which the practice was located. Results: Of the 157 PT locations identified, contact was made with 139 to achieve a response rate of 88.5%. Overall, 96.4% of practices took private insurance, while 51.8% accepted Medicaid. Among those locations that did not accept Medicaid, only 29% were able to refer to a clinic that would accept it. “No contract” was the most common reason why Medicaid was not accepted (39.4%). Average time to first appointment was 5.8 days for privately insured patients versus 8.4 days for Medicaid patients ( P = .0001). There was no significant difference between clinic location (town median income or poverty level) and insurance type accepted. Conclusion: The study results reveal that 43% fewer PT clinics accept Medicaid as compared with private insurance for postoperative ACL reconstruction rehabilitation in a large metropolitan area. Furthermore, Medicaid patients must wait significantly longer for an initial appointment. Access to PT care is still limited despite the expansion of Medicaid insurance coverage to all patients in the state.

Insurance Status and the Use of Guideline Therapy in the Treatment of Selected Cancers

2005 ◽  
Vol 23 (36) ◽  
pp. 9079-9088 ◽  
Author(s):  
Linda C. Harlan ◽  
Amanda L. Greene ◽  
Limin X. Clegg ◽  
Margaret Mooney ◽  
Jennifer L. Stevens ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Population Based ◽  
Insurance Status ◽  
Black Patients ◽  
Rectal Cancers ◽  
Definition Of ◽  
Insured Patients ◽  
The Impact

Purpose This study estimates the impact of type of insurance coverage on the receipt of guideline therapy in a population-based sample of cancer patients treated in the community. Patients and Methods Patients (n = 7,134) from the National Cancer Institute's Patterns of Care studies who were newly diagnosed with 11 different types of cancer were analyzed. The definition of guideline therapy was based on the National Comprehensive Cancer Network treatment recommendations. Insurance status was categorized as a mutually exclusive hierarchical variable (no insurance, any private insurance, any Medicaid, Medicare only, and all other). Multivariate analyses were used to examine the association between insurance and receipt of guideline therapy. Results Adjusting for clinical and nonclinical variables, insurance status was a modest, although statistically significant, determinant of receipt of guideline therapy, with 65% of the privately insured patients receiving recommended therapy compared with 60% of patients with Medicaid. Seventy percent of the uninsured patients received guideline therapy, which was nonsignificantly different compared with private insurance. When stratified by race, insurance was a statistically significant predictor of the receipt of guideline therapy only for non-Hispanic blacks. Conclusion Overall, levels of guideline treatment were lower than expected and particularly low for patients with Medicaid or Medicare only. The use of guideline therapy for ovarian and cervical cancer patients and for patients with rectal cancers was unrelated to type of insurance. Of particular concern is the significantly lower use of guideline therapy for non-Hispanic black patients with Medicaid. After adjusting for other factors, only half of these patients received guideline therapy.

Discharge Delays and Costs Associated With Outpatient Parenteral Antimicrobial Therapy for High-Priced Antibiotics

2019 ◽  
Vol 71 (7) ◽  
pp. e88-e93 ◽  
Author(s):  
Monica L Bianchini ◽  
Rachel M Kenney ◽  
Robyn Lentz ◽  
Marcus Zervos ◽  
Manu Malhotra ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Private Insurance ◽  
Hospital Costs ◽  
Care Facility ◽  
Transitions Of Care ◽  
Beta Lactam ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Subacute Care ◽  
Cost Effective Treatment ◽  
The Impact

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is a widely used, safe, and cost-effective treatment. Most public and private insurance providers require prior authorization (PA) for OPAT, yet the impact of the inpatient PA process is not known. Our aim was to characterize discharge barriers and PA delays associated with high-priced OPAT antibiotics. Methods This was an institutional review board–approved study of adult patients discharged with daptomycin, ceftaroline, ertapenem, and novel beta-lactam-beta-lactamase inhibitor combinations from January 2017 to December 2017. Patients with an OPAT PA delay were compared with patients without a delay. The primary endpoint was total direct hospital costs from the start of treatment. Results Two-hundred patients were included: 141 (71%) no OPAT delay vs 59 (30%) OPAT delay. More patients with a PA delay were discharged to a subacute care facility compared with an outpatient setting: 37 (63%) vs 52 (37%), P = .001. Discharge delays and median total direct hospital costs were higher for patients with OPAT delays: 31 (53%) vs 21 (15%), P &lt; .001 and $19 576 (interquartile range [IQR], 10 056–37 038) vs $7770 (IQR, 3031–13 974), P &lt; .001. In multiple variable regression, discharge to a subacute care facility was associated with an increased odds of discharge delay, age &gt;64 years was associated with a decreased odds of discharge delay. Conclusions OPAT with high-priced antibiotics requires significant care coordination. PA delays are common and contribute to discharge delays. OPAT transitions of care represent an opportunity to improve patient care and address access barriers.

scholarly journals Impact of Insurance Coverage on Outcomes in Primary Breast Sarcoma

Sarcoma ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Julie L. Koenig ◽  
C. Jillian Tsai ◽  
Katherine Sborov ◽  
Kathleen C. Horst ◽  
Erqi L. Pollom
Keyword(s):  
Overall Survival ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Disease Stage ◽  
Insurance Status ◽  
Rare Cancer ◽  
Breast Sarcoma ◽  
Specialized Care ◽  
Insured Patients ◽  
Privately Insured

Private insurance is associated with better outcomes in multiple common cancers. We hypothesized that insurance status would significantly impact outcomes in primary breast sarcoma (PBS) due to the additional challenges of diagnosing and coordinating specialized care for a rare cancer. Using the National Cancer Database, we identified adult females diagnosed with PBS between 2004 and 2013. The influence of insurance status on overall survival (OS) was evaluated using the Kaplan–Meier estimator with log-rank tests and Cox proportional hazard models. Among a cohort of 607 patients, 67 (11.0%) had Medicaid, 217 (35.7%) had Medicare, and 323 (53.2%) had private insurance. Compared to privately insured patients, Medicaid patients were more likely to present with larger tumors and have their first surgical procedure further after diagnosis. Treatment was similar between patients with comparable disease stage. In multivariate analysis, Medicaid (hazard ratio (HR), 2.47; 95% confidence interval (CI), 1.62–3.77; p<0.001) and Medicare (HR, 1.68; 95% CI, 1.10–2.57; p=0.017) were independently associated with worse OS. Medicaid insurance coverage negatively impacted survival compared to private insurance more in breast sarcoma than in breast carcinoma (interaction p<0.001). In conclusion, patients with Medicaid insurance present with later stage disease and have worse overall survival than privately insured patients with PBS. Worse outcomes for Medicaid patients are exacerbated in this rare cancer.

Understanding the impact of primary care providers on treatment decisions for men with localized prostate cancer.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 91-91
Author(s):  
Archana Radhakrishnan ◽  
David Grande ◽  
Linda Crossette ◽  
Justin E. Bekelman ◽  
Craig Evan Pollack
Keyword(s):  
Prostate Cancer ◽  
Primary Care ◽  
Private Insurance ◽  
Primary Care Providers ◽  
Treatment Decisions ◽  
Localized Prostate Cancer ◽  
Definitive Treatment ◽  
Care Providers ◽  
Risk Prostate Cancer ◽  
The Impact

91 Background: Primary care providers (PCPs) play important roles for cancer patients across the care continuum and may help patients make treatment decisions in line with patients’ preferences. However, the extent of PCP involvement is poorly understood. We evaluated how frequently men with localized prostate cancer discuss treatment with their PCP and whether PCP involvement decreased use of definitive treatment, including among those eligible for surveillance according to clinical guidelines. Methods: We mailed surveys to men diagnosed with localized prostate cancer between 2012 and 2013 in the greater Philadelphia area. Patients reporting having a PCP at the time of diagnosis were asked whether their PCP helped decide how to treat their cancer. Definitive treatment was defined as having radical prostatectomy or radiation therapy. Unadjusted and multivariate logistic regression analyses were used to compare sociodemographic and clinical characteristics of patients who did and did not discuss treatment with their PCP. Similar analyses were used to determine effect of PCP involvement on definitive treatment, both overall and in subgroups of men eligible for surveillance (men > 70 years, with limited life expectancy and with low-risk prostate cancer). Results: 3743 men were mailed a survey, 1757 responded, and 1139 were eligible for analyses. Overall, 438 (38.5%) discussed treatment with their PCP. In adjusted analyses, black men were more likely than white men (Odds Ratio 1.89; 95% Confidence Interval 1.22-2.91) and men with Medicare were more likely than men with private insurance (OR 1.61; 95% CI 1.03-2.51) to discuss treatment with their PCP. However, men who had treatment discussions with their PCP were not less likely to receive definitive treatment (p = 0.11), both overall and among those eligible for surveillance. Conclusions: Though a large proportion of men engaged in treatment discussions with their PCP, these discussions were not associated with differences in the receipt of definitive treatment among men with localized prostate cancer. Understanding the content of these discussions can inform interventions that can help patients make preference concordant treatment decisions.

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