{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:50:10Z","timestamp":1788349810425,"version":"build-2803163510"},"reference-count":23,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"\n Importance<\/jats:title>\n Enrollment in Medicare Advantage (MA) accounts for more than half of Medicare beneficiaries. Despite this growth, its impact on access to high-quality cancer surgery remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association between MA enrollment and receipt of surgery at high-quality hospitals among Medicare beneficiaries undergoing major cancer surgery.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This national retrospective cohort study uses Medicare Provider Analysis and Review (MedPAR) data from January 1, 2016, to November 30, 2022. The study included 567\u202f770 Medicare beneficiaries undergoing elective surgery for esophageal, pancreatic, liver, gastric, bladder, colon, kidney, or prostate cancer at hospitals across the United States. Data analysis was performed from August 2024 to July 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Enrollment in Medicare Advantage plan.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was surgery at a high-quality hospital, defined by procedure-specific mortality, risk-adjusted for patient characteristics and reliability-adjusted for differences in case volume using mixed-effects logistic regression models. Adjusted hospital mortality was rank ordered and sorted into quintiles. High quality was defined as hospitals in the quintile with the lowest mortality rates. The secondary outcome was likelihood of bypassing the nearest hospital of lower quality to undergo surgery at a high-quality hospital.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 567\u202f770 beneficiaries undergoing surgery, 351\u202f447 were enrolled in traditional Medicare (TM; 231\u202f104 [65.8%] male, 120\u202f343 [34.2%] female; mean [SD] age, 72.5 [8.0] years) and 216\u202f323 in MA (138\u202f554 [64.0%] male, 77\u202f769 [36.0%] female; mean [SD] age, 72.7 [7.6] years). MA enrollment increased from 32% in 2016 to 46% in 2022. Compared with beneficiaries in TM, MA enrollees were more likely to be from socially vulnerable areas, have more comorbidities, and undergo surgery at nonteaching hospitals across all cancer types. Compared with those in TM, MA beneficiaries were less likely to undergo surgery at a high-quality hospital. For example, 21.7% (95% CI, 20.7%-22.8%) of patients enrolled in TA had an esophagectomy at a high-quality hospital vs 17.3% (95% CI, 16.1%-18.5%) of MA beneficiaries, and 22.6% (95% CI, 22.1%-23.2%) of patients enrolled in TA had a pancreatectomy at a high-quality hospital vs 16.2% (95% CI, 15.6%-16.8%) of those in MA. TM beneficiaries were more likely to bypass a lower-quality hospital to receive surgery at a high-quality hospital for all procedures.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This study found that MA enrollees were less likely to receive cancer surgery at high-quality hospitals and less likely to bypass lower-quality hospitals. These findings suggest that current MA plan networks may limit access to optimal surgical care, raising concerns about the adequacy of cancer care delivery under privatized Medicare.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2025.4320","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T15:01:57Z","timestamp":1760540517000},"page":"1341","source":"Crossref","is-referenced-by-count":6,"title":["Surgery at High-Quality Hospitals Among Medicare Advantage Beneficiaries Undergoing Cancer Surgery"],"prefix":"10.1001","volume":"160","author":[{"given":"Avinash","family":"Maganty","sequence":"first","affiliation":[{"name":"Department of Urology, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Urology, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Dall","sequence":"additional","affiliation":[{"name":"Department of Urology, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preeti","family":"Chachlani","sequence":"additional","affiliation":[{"name":"Department of Urology, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Leick","sequence":"additional","affiliation":[{"name":"Department of Urology, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnav","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel R.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vahakn B.","family":"Shahinian","sequence":"additional","affiliation":[{"name":"Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor"},{"name":"Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent K.","family":"Hollenbeck","sequence":"additional","affiliation":[{"name":"Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"13","key":"soi250068r1","doi-asserted-by":"publisher","first-page":"2302","DOI":"10.1002\/cncr.33498","article-title":"Cancer diagnoses and survival rise as 65-year-olds become Medicare-eligible.","volume":"127","author":"Patel","year":"2021","journal-title":"Cancer"},{"issue":"15","key":"soi250068r2","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1056\/NEJMp1508472","article-title":"Pledging to eliminate low-volume surgery.","volume":"373","author":"Urbach","year":"2015","journal-title":"N Engl J Med"},{"issue":"34","key":"soi250068r3","doi-asserted-by":"publisher","first-page":"3234","DOI":"10.1200\/JCO.18.02035","article-title":"Centralization of high-risk cancer surgery within existing hospital systems.","volume":"37","author":"Sheetz","year":"2019","journal-title":"J Clin Oncol"},{"issue":"7","key":"soi250068r4","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1093\/bjs\/znaa146","article-title":"Effect of centralization and regionalization of pancreatic surgery on resection rates and survival.","volume":"108","author":"Latenstein","year":"2021","journal-title":"Br J Surg"},{"issue":"4","key":"soi250068r5","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1093\/eurpub\/ckv237","article-title":"Improving clinical outcomes through centralization of rectal cancer surgery and clinical audit: a mixed-methods assessment.","volume":"26","author":"Prades","year":"2016","journal-title":"Eur J Public Health"},{"issue":"6","key":"soi250068r6","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1200\/JCO.21.01359","article-title":"Medicare Advantage: a disadvantage for complex cancer surgery patients.","volume":"41","author":"Raoof","year":"2023","journal-title":"J Clin Oncol"},{"issue":"1","key":"soi250068r10","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity measures for use with administrative data.","volume":"36","author":"Elixhauser","year":"1998","journal-title":"Med Care"},{"issue":"6","key":"soi250068r13","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1111\/1475-6773.14211","article-title":"An assessment of completeness and medical coding of Medicare Advantage hospitalizations in two national data sets.","volume":"58","author":"Cotterill","year":"2023","journal-title":"Health Serv Res"},{"issue":"4","key":"soi250068r14","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1097\/SLA.0b013e31824b46ff","article-title":"Reliability adjustment for reporting hospital outcomes with surgery.","volume":"255","author":"Dimick","year":"2012","journal-title":"Ann Surg"},{"issue":"1","key":"soi250068r15","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.53620","article-title":"Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among Medicare beneficiaries.","volume":"6","author":"Diaz","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"22","key":"soi250068r18","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1056\/NEJMsa035205","article-title":"Surgeon volume and operative mortality in the United States.","volume":"349","author":"Birkmeyer","year":"2003","journal-title":"N Engl J Med"},{"issue":"4","key":"soi250068r19","doi-asserted-by":"publisher","first-page":"e315","DOI":"10.1097\/SLA.0000000000005098","article-title":"Medicare Advantage networks and access to high-volume cancer surgery hospitals.","volume":"274","author":"Raoof","year":"2021","journal-title":"Ann Surg"},{"issue":"1","key":"soi250068r20","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.19310","article-title":"Comparison of the quality of hospitals that admit Medicare Advantage patients vs traditional Medicare patients.","volume":"3","author":"Meyers","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"4","key":"soi250068r22","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14308","article-title":"Restrictiveness of Medicare Advantage provider networks across physician specialties.","volume":"59","author":"Feyman","year":"2024","journal-title":"Health Serv Res"},{"key":"soi250068r7","unstructured":"The Commonwealth Fund. Medicare Advantage: a policy primer. Accessed September 10, 2025. https:\/\/www.commonwealthfund.org\/publications\/explainer\/2024\/jan\/medicare-advantage-policy-primer"},{"key":"soi250068r8","unstructured":"Centers for Medicare & Medicaid Services. MEDPAR. Accessed February 4, 2025. https:\/\/www.cms.gov\/data-research\/statistics-trends-and-reports\/medicare-fee-for-service-parts-a-b\/medpar"},{"key":"soi250068r9","unstructured":"Research Data Assistance Center (ResDAC). Master Beneficiary Summary File (MBSF) Base. Accessed February 4, 2025. https:\/\/resdac.org\/cms-data\/files\/mbsf-base"},{"key":"soi250068r11","unstructured":"FEMA. CDC Social Vulnerability Index. June 23, 2022. Accessed February 4, 2025. https:\/\/www.fema.gov\/node\/cdc-social-vulnerability-index"},{"key":"soi250068r12","unstructured":"American Hospital Association. AHA Annual Survey Database. Accessed February 4, 2025. https:\/\/www.ahadata.com\/aha-annual-survey-database"},{"key":"soi250068r16","unstructured":"Centers for Medicare & Medicaid Services. Part C and D performance data. Accessed May 9, 2025. https:\/\/www.cms.gov\/medicare\/health-drug-plans\/part-c-d-performance-data"},{"key":"soi250068r17","unstructured":"National Bureau of Economic Research. Centers for Medicare & Medicaid Services (CMS) descriptions of the drug plans. September 1, 2023. Accessed April 10, 2025. https:\/\/www.nber.org\/research\/data\/centers-medicare-medicaid-services-cms-descriptions-drug-plans"},{"key":"soi250068r21","unstructured":"Jacobson? G, Trilling? A, Neuman? T, Damico? A, Published? MG. Medicare Advantage hospital networks: how much do they vary? KFF. June 20, 2016. Accessed March 4, 2025. https:\/\/www.kff.org\/medicare\/report\/medicare-advantage-hospital-networks-how-much-do-they-vary\/"},{"key":"soi250068r23","unstructured":"Jacobson? G, Rae? M, Neuman? T, Orgera? K, Published? CB. Medicare Advantage: how robust are plans\u2019 physician networks? KFF. October 5, 2017. Accessed September 26, 2024. https:\/\/www.kff.org\/medicare\/report\/medicare-advantage-how-robust-are-plans-physician-networks\/"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2839994\/jamasurgery_maganty_2025_oi_250068_1765206509.37466.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:00:44Z","timestamp":1765382444000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2839994"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":23,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2025.4320","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2025,12,1]]}}}