Hospital–PCP integration and cancer care delivery among Medicare patients with cancer.

Abstract

61 Background: Integration between hospitals and physicians may reshape referral pathways and care delivery, but whether hospital–primary care provider (PCP) integration improves cancer care value remains unclear. Greater organizational alignment could facilitate referral to higher-volume surgical hospitals and timely definitive treatment, but it may also reorganize care without improving outcomes. Methods: We used SEER–Medicare data to examine older adults diagnosed with breast or colorectal cancer during 2009–2018. Patients were attributed to a pre-diagnosis PCP based on the plurality of office-based evaluation and management visits before diagnosis. PCP integration was measured using Medicare billing patterns and defined as at least 75% of claim line items billed through hospital outpatient departments. Outcomes included receipt of surgery at high-volume hospitals (HVHs), surgical volume of the treating facility, definitive surgery within 6 months of diagnosis, total Medicare spending, and survival. Results: The study included 237,271 patients. Hospital–PCP integration was associated with modest but imprecisely estimated increases in referral to HVHs, including 2.14 percentage points using top-tertile combined surgical volume (p=0.20) and 1.02 percentage points using inpatient-only volume (p=0.62). Integration was not associated with meaningful changes in log total Medicare spending (0.007 log points; p=0.85), 1-year survival (-0.49 percentage points; p=0.60), or 5-year survival (-2.95 percentage points; p=0.24). We found some evidence that integration increased receipt of definitive surgery within 6 months of diagnosis by 3.37 percentage points (p=0.05). Conclusions: Hospital–PCP integration did not systematically redirect patients to higher-volume surgical hospitals or generate clear improvements in spending or survival, although it may have increased timely receipt of definitive surgery. These findings suggest that integration may alter cancer care pathways without reliably improving cancer care value. Policymakers and health system leaders should be cautious about assuming that greater organizational alignment alone improves referral quality, lowers spending, or improves survival.