Optimal Mesothelioma Care: Is Reimbursement Structure a Disincentive?

Impending changes in the way hospitals are reimbursed for medical treatments may help improve outcomes for some patients with peritoneal mesothelioma. That conclusion comes from a new study in the Annals of Surgical Oncology, which compared the costs with the money a hospital stands to earn from a popular mesothelioma treatment.

Mesothelioma is a fast-growing and lethal cancer that occurs most often in people who worked in jobs that exposed them to asbestos. While most cases of mesothelioma occur on the pleura, the lining around the lungs, about a third of cases occur on the peritoneum, which lines the abdomen.

Increasingly, the gold standard treatment for people with peritoneal mesothelioma is cytoreductive surgery (CRS) to remove as much of the tumor as possible followed by heated intra-peritoneal chemotherapy (HIPEC) to kill any remaining cells. The CRS/HIPEC treatment is complex and lengthy but has been found to dramatically improve survival in patients with peritoneal mesothelioma.

But a new study conducted by surgical oncologists at Winship Cancer Institute in Atlanta finds that hospitals actually make money when privately-insured CRS/HIPEC patients experience major complications. At the same time, hospitals tend to lose money when they perform CRS/HIPEC on Medicaid patients.

Researchers examined the cases of 64 patients who were treated with CRS/HIPEC for various cancers, including mesothelioma, at Emory University. Sixty-six percent of patients experienced complications, including 13 whose complications were major. Because complications resulted in increased cost and higher reimbursements, the hospital made about $36,285 per privately-insured patient. However, because of the difference in reimbursement, the hospital reportedly experienced a net loss of $54,274 per Medicare/Medicaid patient who underwent CRS/HIPC.

Fortunately, the authors say a solution to this problem is coming, in the form of “bundled” insurance payments that will reimburse hospitals more when patients experience fewer complications. “With these impending changes, hospitals must place emphasis on value, recalculate the reimbursement necessary for financial viability, and focus on decreasing costs and minimizing complications,” writes lead author Dr. Malcolm H. Squires.

Because mesothelioma can take decades to develop, most mesothelioma patients are over 65 and many rely on Medicare as their primary insurance.

Source:

Squires, MH et al, “Association between hospital finances, payer mix, and complications after hyperthermic intraperitoneal chemotherapy: deficiencies in the current healthcare reimbursement system and future implications”, September 24, 2014, Annals of Surgical Oncology, Epub ahead of print