The University of California at San Francisco Hospital in 2014 performed 237 surgeries for prostate cancer. Less than three miles away, the Kaiser Foundation Hospital performed 30 such procedures. And four miles south, San Francisco General Hospital performed just six.
Radical prostatectomy is a common treatment for early stage prostate cancer. But as many as 24% of hospitals in California performed only one or two of these surgeries that year.
It's been well documented in the medical literature that hospitals that perform more procedures tend to have better outcomes, including lower mortality and complication rates. But most patients don't have a way to track which are the high-volume centers. Even insurance companies and hospitals themselves might not have that data.
“Immediately people think these are small, rural hospitals,” said Stephanie Teleki, a senior program officer with the California Healthcare Foundation, which has sought to identify high-volume centers. “This happens in L.A., it happens in rural areas.”
In a study of hospital discharges across the state, the foundation looked at 11 types of cancer to compile data on how many oncologic surgeries each hospital performed in 2014. It found wide variation in volume. More importantly, it found that almost 75% of California hospitals performed surgery for at least one of these 11 cancers only once or twice.
The findings held true in both rural and urban locations. And 70% of the patients who went to a low-volume hospital were less than 50 miles from a high-volume facility.
“I think there's just a lack of awareness,” Teleki said. “And when you give this to them, they understand it in a very visceral way. It's not a complicated quality measure.”
Although the study was published late last year, it is receiving new attention this week after it was published in Health Affairs as a blog post. And the foundation is hoping the results receive wider attention.
The group has created a website for consumers where patients can download data for a particular hospital. But consumers aren't necessarily the primary audience for its results. “I think we know a lot of patients can't vote with their feet because they're locked into their network,” Teleki said.
Instead, the foundation hopes that hospitals will track their own procedures, and insurers will hold them to task. Hospitals that perform only one or two surgeries to treat a particular type of cancer might want to stop performing them entirely, Teleki said. With CMS penalties for readmissions or other adverse events, the financial repercussions of taking those cases could outweigh the benefits, she argued.
Larger health systems also can use the data to channel patients to particular hospitals within the group, designating their own centers of excellence for different surgeries, Teleki said. Kaiser Permanente, she added, is an example of a system that's already using this strategy.
And as for health plans, she said, “You simply don't allow these procedures to occur at places that only do one or two.”
Insurers are already taking note. The foundation's study “provides both the evidence and the data to start including volume as a criteria in our Centers of Excellence research,” Dr. Jennifer Malin, staff vice president of clinical strategy at insurance giant Anthem, wrote in a post this week on the Health Care Blog. “While the centers have focused more broadly on different types of cancer, we can use these data as a basis and may start to focus on the outcome-surgery volume link.”
The data also will be discussed this month at a meeting of the American Society of Clinical Oncology, Teleki said.
High volume cancer hospitals have more than just added experience in performing cancer surgeries. They're also more likely to be following the most current standard of care, according to a poster presented last year at an ASCO breast cancer symposium.
California is the first state to analyze cancer surgery data, but the foundation hopes the momentum will continue across the country. “There are a lot of other states that could do this analysis, too,” Teleki said.
