Table 1.
Beneficiaries in the Physician Group Practice Demonstration descriptive characteristics for participating sites and local controls. Source: Medicare claims files, 2001-2005 (20% sample), 2006-2009 (100%).
| Beneficiaries with cancer |
||||
|---|---|---|---|---|
| Participants |
Control |
|||
| Pre (2001-2004) | Post (2005-2009) | Pre (2001-2004) | Post (2005-2009) | |
| N | 18,483 | 104,766 | 137,563 | 727,969 |
| Demographics | ||||
| Mean age | 74.4 | 74.1 | 74.9 | 74.7 |
| % Female | 48.8 | 50.1 | 48.0 | 48.0 |
| % Medicaid | 8.5 | 9.9 | 8.4 | 9.2 |
| % Black | 1.4 | 1.8 | 3.2 | 3.6 |
| % < Age 65 | 6.2 | 8.2 | 5.6 | 7.2 |
| % Disabled and ≥Age 65a | 6.2 | 6.8 | 7.1 | 7.2 |
| % Blacks below FPL in zipcode | 18.6 | 18.4 | 22.3 | 21.5 |
| % Non-Black below FPL in zipcode | 8.1 | 8.0 | 8.3 | 8.2 |
| % Black high-income in zipcode | 11.5 | 13.3 | 11.5 | 14.2 |
| % Non-Black high-income in zipcode | 10.8 | 12.0 | 8.4 | 10.1 |
| Risk adjustment | ||||
| Mean HCC | 1.83 | 2.01 | 1.82 | 1.98 |
| Mean comorbidity count (of 10 below) | 1.13 | 1.15 | 1.17 | 1.20 |
| % Metastatic cancerb | 14.3 | 14.1 | 13.1 | 12.4 |
| % Chronic pulmonary disease | 17.7 | 16.9 | 18.6 | 18.4 |
| % Coronary artery disease | 20.9 | 19.4 | 22.4 | 22.0 |
| % Congestive heart failure | 11.8 | 10.3 | 12.7 | 11.2 |
| % Peripheral vascular disease | 8.0 | 8.5 | 8.7 | 9.3 |
| % Severe chronic liver disease | 0.5 | 0.6 | 0.5 | 0.7 |
| % Diabetes with end organ damage | 1.9 | 2.0 | 1.8 | 1.8 |
| % Chronic renal failure | 3.3 | 6.4 | 3.7 | 6.5 |
| % Dementia | 4.7 | 4.7 | 5.0 | 5.5 |
| % Diabetes (without end organ damage) | 17.5 | 20.4 | 19.7 | 21.4 |
| Low-variation indicators (per 1000) | ||||
| Hip fracture | 10.69 | 9.79 | 11.41 | 10.30 |
| Stroke | 11.13 | 10.09 | 12.22 | 10.80 |
| Acute myocardial infarction | 14.88 | 12.10 | 15.09 | 11.76 |
| Cancer typeb | ||||
| Cancer of prostate | 26.2 | 24.1 | 28.3 | 27.4 |
| Cancer of breast | 22.4 | 23.0 | 22.0 | 22.5 |
| Cancer of colon | 9.8 | 9.3 | 11.0 | 9.8 |
| Cancer of bronchus, lung | 8.9 | 9.2 | 8.8 | 9.1 |
| Cancer of bladder | 6.5 | 6.8 | 8.0 | 8.0 |
| Leukemias | 4.3 | 4.7 | 3.4 | 3.9 |
| Melanomas of skin | 4.1 | 4.7 | 2.9 | 3.6 |
| Cancer of head and neck | 3.9 | 3.5 | 3.0 | 3.1 |
| Cancer of rectum and anus | 3.8 | 3.4 | 4.2 | 3.4 |
| Cancer of uterus | 3.1 | 2.9 | 2.5 | 2.4 |
| Cancer of kidney and renal pelvis | 2.4 | 2.6 | 2.6 | 2.8 |
| Cancer of ovary | 1.9 | 2.0 | 1.6 | 1.7 |
| Multiple myeloma | 1.5 | 1.8 | 1.4 | 1.5 |
| Cancer of cervix | 1.2 | 0.8 | 1.2 | 0.9 |
| Cancer of esophagus | 1.1 | 1.0 | 0.9 | 0.9 |
| Cancer of pancreas | 1.1 | 1.3 | 1.0 | 1.1 |
| Cancer of stomach | 1.0 | 0.8 | 1.0 | 0.9 |
| Cancer of bone and connective tissue | 1.0 | 1.1 | 0.8 | 0.9 |
| Cancer of brain and nervous system | 1.0 | 1.1 | 0.8 | 1.0 |
| Cancer of other GI organs, peritoneum | 0.9 | 1.2 | 1.2 | 1.1 |
| Cancer of other female genital organs | 0.9 | 0.8 | 0.7 | 0.6 |
| Non-Hodgkins lymphoma | 0.9 | 0.8 | 0.7 | 0.6 |
| Cancer of thyroid | 0.8 | 1.2 | 0.9 | 1.1 |
| Hodgkins disease | 0.6 | 0.6 | 0.4 | 0.4 |
| Cancer of liver and intrahepatic bile duct | 0.5 | 0.7 | 0.7 | 0.7 |
| Cancer, other respiratory and intrathoracic | 0.4 | 0.3 | 0.3 | 0.3 |
| Cancer of other urinary organs | 0.3 | 0.3 | 0.4 | 0.4 |
| Cancer of other male genital organs | 0.2 | 0.1 | 0.1 | 0.1 |
| Cancer of testis | 0.1 | 0.2 | 0.1 | 0.2 |
| Annual spending | ||||
| Mean per capita payments | $18,594 | $20,066 | $18,100 | $19,921 |
| Mean payments—acute care | $8116 | $7736 | $7520 | $7617 |
| Mean payments—procedures | $2301 | $2709 | $2365 | $2754 |
| Mean payments—cancer specific | $1708 | $1572 | $1716 | $1441 |
| Mean payments—chemotherapy | $1161 | $822 | $1164 | $715 |
| Mean payments—cancer procedures | $631 | $832 | $639 | $800 |
| Mean payments—Evaluation & management | $1482 | $1626 | $1475 | $1602 |
| Mean payments—Double medical equipment | $1211 | $1774 | $889 | $1281 |
| Mean payments—Skilled nursing facility | $987 | $1186 | $1109 | $1360 |
| Mean payments—imaging | $854 | $1138 | $812 | $1102 |
| Mean payments—home health | $574 | $625 | $571 | $675 |
| Mean payments—tests | $557 | $782 | $541 | $757 |
| Mean payments—long-term care | $533 | $688 | $614 | $697 |
| Outcomes | ||||
| % Diedb | 11.6 | 10.3 | 11.3 | 10.5 |
| % Death in hospitalb | 3.0 | 2.6 | 3.4 | 2.9 |
| % Hospice useb | 7.1% | 6.8% | 6.2% | 6.5% |
| Mean Hospice daysb Mean Hospice days among hospice usersb Mean ICU days |
3.16 44.38 0.60 |
2.83 41.54 0.61 |
2.73 43.73 0.73 |
2.87 44.02 0.81` |
| % who use acute care (%) | 42.1 | 39.4 | 43.0 | 40.8 |
| Mean hospital discharges | 0.857 | 0.806 | 0.852 | 0.832 |
| Mean days in hospital | 4.35 | 3.96 | 4.58 | 4.21 |
Notes: Cases and controls are weighted by person-years. Controls are weighted such that the sum of the weights equals the number of cases by county and cancer type. Spending is inflated to 2009 US dollars using the gross domestic product deflator. Proportion in a high income group is defined by race at the 85th percentile.
a
Disability is defined using original reason for entitlement. is weighted using only county weights (not follow up time which incorporates deaths).
b
Variable