Policies Encouraging High-Volume Facilities Disadvantage Oncology Patients in Rural Areas

A new analysis published in the “JCO Oncology Practice” journal has revealed that policies encouraging high-volume medical facilities may be harming cancer patients living in rural areas. Health policy researchers at the University of Pittsburg School of Public Health discovered that cancer patients in rural Pennsylvania counties seem to be choosing to go to lower-volume health facilities closer to their homes even when they know higher-volume facilities may provide better outcomes.

Rural areas often suffer from shortages of critical skills as most skilled professionals opt to move to urban areas for better pay. Rural America has a major shortage of experienced surgeons as rural areas struggle to attract and retain medical professionals over the long term. These shortages are even more acutely felt by rural cancer patients thanks to policies and programs designed to centralize cancer treatment services, especially surgical treatment, in high-volume medical facilities in mostly urban regions.

Such policies could lead to the association of insurance reimbursements with metrics that include the volume of surgeries, potentially disadvantaging cancer patients in rural areas who opt to visit facilities that have lower surgical volumes but are closer to home.

Senior study author and Pitt Public Health’s Department of Health Policy and Management associate professor Lindsay Sabik, PhD, said that the research team’s findings indicate that narrowing the focus to hospital surgical volumes and making insurance reimbursements based on volumes could mask the “complexities and trade-offs” with the potential of improving patient experiences and outcomes.

Sabik and her colleagues collected statewide data on adult patients with cancer who had surgery from 2017 to 2020 from the Pennsylvania Health Care Cost Containment Council. They found that rural cancer patients with cancers that required less-complex surgeries tended to visit local hospitals rather than high-volume facilities even though such facilities are known to produce better outcomes. Policies that prize high-volume facilities also increase overall costs for rural patients through extra travel and board expenses.

Furthermore, traveling tens or even hundreds of miles for quality treatment usually pulls rural patients away from their family, friends and support networks at a time when they need support the most. In the largely rural city of Elko, for instance, a large portion of physicians comprise medical students doing their residencies, meaning patients in such regions are often unsure of how long their physicians will stay before being forced to move on. Even though some experts say increasing the number of rural medical residency programs is key to filling critical shortages, more than 95% of U.S. residencies currently take place in urban areas.

In the coming years, the R&D programs being undertaken by entities such as CNS Pharmaceuticals Inc. (NASDAQ: CNSP) could avail brain cancer drugs that are available on the mass market and benefit not only patients in urban areas but also those in rural areas.

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