Treatment of patients with head and neck cancer is increasingly moving to teaching hospitals and academic centers, according to a study now available online ahead of print in JAMA Otolaryngology Head & Neck Surgery (doi:10.1001/jamaoto.2013.4525).
For the study, Neil Bhattacharyya, MD, Professor at Harvard Medical School and Associate Chief of the Division of Otolaryngology at Brigham and Women's Hospital, and Elliot Abemayor, MD, PhD, Professor of Head and Neck Surgery at David Geffen School of Medicine at UCLA, analyzed all inpatient admissions for a primary head and neck cancer diagnosis in the Nationwide Inpatient Sample database during the calendar years 2000, 2005, and 2010. The aim was to determine trends associated in hospital teaching status, hospital bed size, and the primary expected payer for the hospital stay. Admissions for either surgical and/or nonsurgical services were considered.
The researchers did not find a significant overall change in the distribution of cases among hospital size or in the distribution of payers for inpatient cancer care. The results did show, however, that the concentration of inpatient head and neck cancer care was shifting by 2010 such that nearly 80 percent of inpatient cancer care occurred at teaching hospitals—specifically:
- The estimated inpatient head and neck cancer stays in the U.S. were 28,862 in 2000; 33,817 in 2005; and 37,354 in 2010; and
- The percentage of admissions to teaching hospitals during those years was 61.7%, 64.2%, and 79.8%, respectively.
“This study is one of the first to document that regionalization is occurring among academic medical centers,” Abemayor said in a telephone interview. There are two key implications of that finding, he said.
Pay for performance should be reexamined as a benchmark for reimbursement, because outcomes at academic medical centers are likely to be heavily influenced by the fact that patients may have more extensive illness when referred to these centers and may need more intensive procedures after prior treatments with radiation and chemotherapy, he said.
“If you're going to pay for a certain benchmark, you have to change the benchmark in accordance for those kinds of patients.”
There are also important implications for future education of residents and measures of achieved competency, he added. “All residents do not necessarily need to be taught all head and neck procedures because a majority of them will not use them the majority of the time,” Abemayor said.