Improving Breast Cancer Outcomes for Medicaid Recipients

New York State Cancer Registry

The New York State (NYS) Office of Health Insurance Programs (OHIP), in collaboration with the New York State Cancer Registry (NYSCR), expanded on a previous New York study¹ which found that hospital breast cancer surgery volume has a strong positive effect on five-year survival. The more recent unpublished study included outpatient surgical events and analyzed the effect of physician surgical volume.

NYSCR data were linked to the NYS hospital discharge database. Information on age, stage at diagnosis, race and ethnicity, vital status, and census tract-level socioeconomic status (SES) were obtained from the registry. Information on inpatient and outpatient surgical volume, physician surgical volume, type of insurance, and comorbidity were obtained from the discharge database.

Three- and five-year survival rates were assessed, adjusting for clinical factors and SES, for inpatient/outpatient and exclusively inpatient admissions, respectively. In unadjusted analyses, both hospital and surgical volume were strong predictors of survival. Within each hospital volume category, women treated by higher-volume surgeons experienced improved outcomes. However, hospital volume was not significant in multivariate analyses that also controlled for surgeon volume. Since the two are very highly correlated and facility volume is easier to measure than surgeon volume, the NYS OHIP adopted a reimbursement policy tied to facility volume.

A policy to contract with high-surgical-volume facilities was implemented to improve breast cancer outcomes for NYS Medicaid recipients. All-payer breast cancer surgical volumes are reassessed annually to determine which hospitals and ambulatory surgery centers meet volume thresholds and will be allowed to serve Medicaid recipients with breast cancer. This successful project has led to continued collaboration between the NYS Medicaid program and the NYSCR. The two programs are engaged in research and evaluation to improve cancer care quality and outcomes in the Medicaid population and to reduce the cost associated with cancer care.

Reference

¹Roohan PJ, Bickell NA, Baptiste MS, Therriault GD, Ferrara EP, Siu AL. Hospital volume differences and five-year survival from breast cancer. American Journal of Public Health 1998;88(3):454–457.