Self-referrals increase costly cancer treatment

A study published yesterday in the New England Journal of Medicine found that doctors who can profit from using expensive intensity-modulate radiation therapy (IMRT) are twice as likely to recommend it--even without definitive data that it is better than traditional treatment.

In the study, author Jean M. Mitchell, Ph.D., used Medicare claims from 2005 to 2010 to sample two groups: one of self-referring urology groups in private practice and matched control group comprising 35 non-self-referring urology groups, and the other comprising non-self-referring urologists working at 11 National Comprehensive Cancer Network centers matched with 11 self-referring urology groups in private practice. Mitchell compared the use of IMRT in the periods before and during ownership, evaluating how often doctors suggested the treatment when they were self-referring.

Mitchell concluded that urologists "who acquired ownership of IMRT services increased their use of IMRT substantially more than urologists who did not own such services. Allowing urologists to self-refer for IMRT may contribute to increased use of this expensive therapy."

Mitchell told Reuters, "Their behavior didn't change at all. Given the lack of difference in clinical outcomes, if you're a patient you have to ask yourself why you're getting this extensive treatment. I know one of these centers has limousine service that picks people up 50 miles away."

Some physicians, speaking to Reuters, didn't buy the inference that use of IMRT was directly linked to profit.

"The wrong thing to look at is total cost," Bruce Roth, M.D., an oncologist at the Washington University School of Medicine in St. Louis, told Reuters. "It's no doubt that (IMRT) costs more, but it's probably better than conventional radiotherapy. But if you're going to make the hypothesis that the urologists are doing it for financial reasons, you should look at the flow of money back to the physicians, not just the costs, because this technology doesn't come free--and all of that difference in dollars isn't flowing into the urologists' pockets."

Meanwhile, industry groups have objected to the findings and questioned the motives behind the report, according to an article on Aunt Minnie.

Mitchell argued that Medicare is paying a lot of money for expensive treatment for older patients that isn't necessarily giving them more years of life.

To learn more:
- see the NEJM study abstract
- here's the Reuters article 
- read the Aunt Minnie story

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