By Will Boggs, MD
Published: September 9, 2013

NEW YORK (Reuters Health) Sep 09 – An increasing proportion of head and neck cancers is being treated at teaching hospitals and academic centers – which may be good news for patients, and bad news for the hospitals.

“Higher volume centers end up doing more complex work,” Dr. Eliot Abemayor from David Geffen School of Medicine at UCLA, Los Angeles, California told Reuters Health by email. “Since more specialized centers are doing this work, they cannot be held accountable to having poorer outcomes per se since the patients in general are the sickest and most complex.”

The care of patients with head and neck cancer is labor intensive and expensive, and over the past decade, a greater number of patients seem to be receiving care at teaching hospitals and academic institutions than at local or community-based institutions.

In an effort to document this trend and its implications, Dr. Abemayor and Dr. Neil Bhattacharyya from Brigham and Women’s Hospital in Boston used data from the Nationwide In-patient Sample for the calendar years 2000, 2005, and 2010, which included roughly 29,000, 33,500, and 37,500 inpatient hospital head and neck cancer stays, respectively.

This trend represents an increase of approximately 29% over the three study years, the researchers note.

These data demonstrated a significant increase in the proportion of stays for teaching hospitals, from 61.7% in 2005 to 79.8% in 2010 (p<0.001).

At the same time, the number of admissions to medium- bed-size hospitals for head and neck cancer inpatient stays decreased, although the overall change was not statistically significant.

Although a head and neck patient in 2005 was only 10% more likely to be admitted to a teaching hospital than in 2000, a patient in 2010 was 2.5 times more likely to be admitted to a teaching hospital than in 2000, the research team reported September 5 online in JAMA Otolaryngology Head and Neck Surgery.

Medicare or Medicaid covered more than half the patients in both 2000 and 2010, and there was no significant difference in payer mix between teaching and nonteaching hospitals.

“On the positive side, regionalization of head and neck cancer care to teaching institutions is likely to offer significant individual patient and societal benefit, although such benefits will need to be confirmed over time,” the authors say. “The net result of such an increase in volume would be anticipated improved quality and outcomes.”

Because most head and neck cancers will be performed at academic centers (and few elsewhere), goals and objectives of residency training as they pertain to head and neck surgical oncology may need to be revamped, Dr. Abemayor said. Earlier subspecialization may be one approach.

“Irrespective of payer distribution,” the authors conclude, “such intrinsically more expensive care must be part of the discussion between hospitals, health care providers, and payers when bundled payments are made if the fiscal viability of academic institutions is to be maintained.”

As for improving reimbursement for teaching hospitals, Dr. Abemayor said, “The major way is for the teaching hospitals not to be coerced into accepting reimbursement based on formulas that are unrealistic and outcomes driven. If they are doing the majority of cases, frankly, payers have nowhere else to go.”


*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.


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