By Jay Hancock
The Baltimore Sun, January 17, 2012
Four years ago, doctors at Chesapeake Urology Associates started ordering the most expensive kind of prostate-cancer therapy for many more of their patients.
Before 2007, the large, multi-office practice was prescribing the treatment, known as intensity modulated radiation therapy, for 12 percent of its prostate-cancer patients covered by Medicare, according to data compiled by a Georgetown University researcher. But starting in mid-2007, Chesapeake Urology’s referral rate for IMRT more than tripled, rising to 43 percent of the Medicare cases.
What could have caused such a sharp change?
It couldn’t have been because IMRT, which costs about $40,000 per treatment, was new. Maryland hospitals had been offering it for years.
It couldn’t have been because IMRT was better.
“No randomized clinical trials show that prostate cancer patients receiving IMRT live longer or experience fewer long-term side effects than those getting the alternatives” of radiation-seed therapy or surgery, said Dr. James Mohler, a urologist at Roswell Park Cancer Institute in Buffalo, N.Y., and chairman of the national committee that sets standards for prostate-cancer care.
Chesapeake Urology tripled its percentage of prescriptions for IMRT after the practice acquired its own IMRT machine in 2007. The more patients the Baltimore-area urologists referred for that expensive therapy alternative, the more revenue and profits they would generate.
“They’re steering patients to IMRT because that’s where they make their money,” said Jean Mitchell, a professor and health care economist at Georgetown who’s working on a national study about IMRT referrals. “They’re making a ton of money out of this. There’s no question about it. At the expense of the taxpayers” who finance Medicare.
http://www.baltimoresun.com/health/bs-bz-hancock-chesapeake-urology-20120114,0,670418.column
Comment:
By Don McCanne, MD
Technology that improves patient outcomes and reduces costs is great. Technology that increases costs, produces undesirable side effects, and provides no evidence of extended life expectancy is… well… not so great, except for meeting the financial goals of the entrepreneurial owners of the technology. And when the owners of the technology are the same trusted physicians who are prescribing it, that’s reprehensible.
Theoretically a government-funded and government-administered health care financing program would have the power to prevent these abuses. Yet this diversion of radiation treatment fees to the referring physicians is occurring within the Medicare program. So simply expanding Medicare to everyone alone is not enough to fix our dysfunctional financing system.
A properly designed single payer national health program would do far more than simply remove private insurers from the system. In this instance the need for the radiation equipment would be determined by medical science confirming the value of the intervention. The decision to purchase the equipment would be made through regional planning based on need. The payment for the equipment would be through separate budgeting of capital improvements. The ownership would be public or non-profit and would have no investors to draw off profits.
Physicians would be paid appropriately for their professional services as urologists and radiation oncologists, but they would not receive extra dividends based on their insight as to the potential lucrative benefits of personally investing in the equipment.
So about that Medicare for all. We speak of an improved Medicare for all, but the improvements would have to be monumental.