Highlight
This large-scale retrospective cohort study highlights a critical disparity between Medicare Advantage (MA) and traditional Medicare (TM) beneficiaries in access to high-quality cancer surgery. MA enrollees were significantly less likely to undergo surgery at hospitals with the lowest procedure-specific mortality and less likely to bypass nearby lower-quality hospitals compared to TM beneficiaries. This suggests that MA plan networks may constrain patient choice and access to optimal surgical care.
Study Background
Medicare Advantage (MA) plans have grown substantially, now covering over half of all Medicare beneficiaries. These privatized plans, with managed care networks, aim to provide cost-effective care but raise concerns regarding access to specialized, high-quality services. Major cancer surgeries such as esophagectomy, pancreatectomy, and others demand complex care at high-volume, high-quality centers to optimize outcomes. The impact of MA enrollment on receipt of cancer surgery at such hospitals remains unclear. Understanding this issue is vital given the increasing MA coverage and the critical role of hospital quality in cancer surgery outcomes.
Study Design
This was a national retrospective cohort study analyzing Medicare Provider Analysis and Review (MedPAR) data from January 1, 2016, to November 30, 2022. The cohort comprised 567,770 Medicare beneficiaries aged approximately 73 years on average undergoing elective surgery for esophageal, pancreatic, liver, gastric, bladder, colon, kidney, or prostate cancer across U.S. hospitals. The primary exposure was enrollment in Medicare Advantage versus traditional Medicare. The main outcome was surgery performed at a high-quality hospital, defined as those in the lowest quintile of mortality risk after adjusting for patient characteristics and hospital case volume via mixed-effects logistic regression. Secondary analysis assessed the likelihood of bypassing the nearest lower-quality hospital to receive surgery at a high-quality hospital. Data analysis occurred from August 2024 to July 2025.
Key Findings
MA enrollment among surgical cancer patients rose from 32% in 2016 to 46% in 2022, reflecting broader trends in Medicare coverage. Patients in MA plans, compared to TM beneficiaries, were more often from socially vulnerable communities and had higher comorbidity burdens. They were also more frequently treated at nonteaching hospitals.
Critically, MA beneficiaries were less likely to have cancer surgery at high-quality hospitals across all studied cancer types. For instance, only 17.3% of MA patients undergoing esophagectomy received surgery at a high-quality hospital versus 21.7% in TM. Similarly, 16.2% of MA enrollees had high-quality hospital pancreatectomies compared with 22.6% for TM beneficiaries. These differences were statistically significant.
Furthermore, TM patients showed a greater propensity to bypass their nearest lower-quality surgical hospital in favor of a high-quality center. In contrast, MA enrollees were less likely to make such bypasses across all cancer surgeries. This likely reflects restrictions imposed by MA plan networks in provider availability and coverage.
Expert Commentary
This study provides compelling evidence that Medicare Advantage plan networks may inadvertently limit access to optimal hospital care for major cancer surgeries. High-quality cancer surgery is often concentrated in specialized centers with experience and multidisciplinary expertise that lead to lower mortality and better postoperative outcomes. Restricting patient choice due to narrow MA networks may expose vulnerable populations to suboptimal care settings, thus potentially impacting survival and quality of life.
These findings align with growing concerns about privatized Medicare plans prioritizing cost control over access. However, potential confounders include higher comorbidity and socioeconomic disadvantage among MA enrollees, possibly influencing hospital selection. Additional studies are warranted to evaluate outcomes such as cancer survival, patient preferences, and the impact of MA network designs on long-term care quality.
Policy implications may include revisiting MA network adequacy standards and encouraging transparent hospital quality reporting to empower informed surgical decisions. Clinicians should be aware of these disparities when advising patients enrolled in MA plans.
Conclusion
This nationwide retrospective analysis highlights that Medicare Advantage beneficiaries undergoing major cancer surgery are less likely to receive care at high-quality hospitals and less likely to bypass lower-quality centers compared with traditional Medicare enrollees. These disparities raise important concerns about the adequacy of cancer surgical care access under privatized Medicare plans. Ensuring equitable referral and network design will be essential as MA enrollment continues to expand.
Future research should explore the longitudinal impact on cancer-specific outcomes and investigate interventions targeting network adequacy and patient navigation to optimize surgical cancer care delivery for all Medicare beneficiaries.
Funding and ClinicalTrials.gov
The original study did not disclose specific funding sources within the abstract. No registered clinical trial number was reported.
References
- Maganty A, Liu X, Dall C, et al. Surgery at High-Quality Hospitals Among Medicare Advantage Beneficiaries Undergoing Cancer Surgery. JAMA Surg. 2025 Oct 15:e254320. doi:10.1001/jamasurg.2025.4320. Epub ahead of print. PMID: 41091515; PMCID: PMC12529325.
