November 4, 2010

THANKS, W:

Use of Prostate Cancer Treatment Fell When Medicare Paid Docs Less: Financial incentives influence treatment rates, study finds (Amanda Gardner, 11/03/10, HealthDay)

"Clearly, there are other areas where this would occur, even in other areas of prostate cancer right now. For instance, proton beam radiation therapy reimburses very well so there are certain medical centers that are really pushing it," agreed Dr. Judd W. Moul, chief of the division of urologic surgery at Duke University Medical Center in Durham, N.C.

"Another classic example is imaging," Moul said. "CAT scans reimburse pretty well so a lot of doctors put CAT scan units into their offices. That's a profit center."

The Medicare Modernization Act that went into effect in 2004 and 2005 slashed physicians' reimbursement for androgen-deprivation therapy by about 50 percent.

In the 1990s, when reimbursement rates were much higher, the number of men receiving the therapy exploded. The treatment is considered effective in more advanced, higher-risk cancers and not so useful in those with low-grade tumors still confined to the prostate, although new evidence on hormonal therapy continues to emerge.

"There was a significant difference between what the doctors were able to buy the drugs for and what Medicare would cover when they were administered," said Moul. "The bottom line is they were very profitable for the physicians."

To assess the impact of the Modernization Act, Shahinian and his colleagues looked at records of almost 55,000 men diagnosed with prostate cancer between 2003 and 2005. Patients were separated out based on the characteristics of their tumors -- for example, localized vs. locally advanced, and whether evidence existed to support use of this therapy in those cases. An intermediate category was established for cases where the decision was less clear-cut.

Unnecessary use of androgen-deprivation therapy declined from 38.7 percent in 2003 to 30.6 percent in 2004, then to 25.7 percent in 2005, the study authors reported.

But there were no changes in appropriate use of the therapy, which stayed stable, the researchers said.


Now shift the costs directly to consumers and watch the decline.

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Posted by Orrin Judd at November 4, 2010 5:15 AM
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