Navigation Links
Penn study: Financial incentives affect prostate cancer treatment patterns
Date:3/12/2013

Philadelphia - According to a new study by researchers at the Perelman School of Medicine at the University of Pennsylvania, prostate cancer patients of urologists who own expensive radiation equipment are more likely to receive radiation treatment in lieu of surgery than patients treated by urologists without an ownership stake in the equipment. The study, now available online in the Journal of Urology, found that integrated prostate cancer centers (IPCCs), where urology and radiation oncology practices are combined, use expensive radiation-based treatments at higher rates than other forms of prostate cancer treatment, and reduce their use of prostatectomy (the surgical removal of all or part of the prostate gland).

Intensity-modulated radiation therapy (IMRT) used radiation beams of varying intensities and shapes that attack tumors. The changes in shape allow for reduced exposure of healthy tissue to radiation and limit the side effects of treatment. In the case of most IPCCs, urologists buy radiation equipment called linear accelerators, complex machines which can cost more than $1.5 million. The ownership stake in the equipment provides these physicians with reimbursement each time the equipment is used to treat a patient.

"Our study found that ownership of radiation therapy equipment that offers high reimbursement rates has an impact on treatment patterns for patients with prostate cancer," said Justin Bekelman, MD, assistant professor of Radiation Oncology at Penn Medicine. "IMRT increases for these patients while surgeries decrease when financial incentives are present. We also found increases in IMRT use in markets where urologists do not own the equipment, but no corresponding decreases in surgery, which reflects the overall increase of advanced radiotherapy, an expensive treatment for prostate cancer."

In the new study, investigators examined prostate cancer treatment patterns among Medicare beneficiaries before and after conversion of a urology practice to an IPCC in July 2006. Patients were classified into three groups: (1) those seen by IPCC physicians; (2) those living in the geographic region ("nearby") and not seen by IPCC physicians; and (3) those living elsewhere in the state. Changes in treatment among the three groups were then compared, adjusting for patient, clinical, and socio-economic factors.

The researchers discovered that IMRT usage increased in all three patient groups, but the increase was substantially larger in the IPCC group (from 24 percent to 46 percent of all treatment cases) and the nearby group (16 percent to 38 percent) compared to the rest of the state (14 percent to 23 percent). Prostatectomy declined significantly: a reduction of almost 13 percentage points among the IPCC group compared to the nearby group and a 12 percentage point decline compared to the rest of the state.

Prostate cancer costs exceed $12 billion annually and account for nearly 10 percent of the total cost of cancer care to Medicare. Introduced in the late 1990s and now the most common radiotherapy treatment for prostate cancer, costs for IMRT can range from $25,000-$40,000 per treatment course, compared to $8,000-$13,000 for a prostatectomy and $12,000 for other alternative treatments.

"These findings highlight the importance of full disclosure by physicians to patients when the physicians stand to benefit financially from referrals or treatments," said Bekelman. "In all cases, patients should seek balanced opinions on their treatment options from both surgeons and radiation oncologists."

Federal and state statutes bar doctors from referring patients to businesses in which they have a financial interest, or from receiving money for referrals. But over the years, exemptions have evolved. The in-office ancillary services exemption permits referrals when physicians maintain care oversight of the service within their office setting.

"Enhancing coordination of care is an important aspect of health care reform that is expected to lead to better outcomes and lower costs," said Andrew J. Epstein, PhD, research associate professor of Medicine and a co-author on the new study. "At the same time, this study also underscores that increased coordination in the absence of payment reform can lead to unintended consequences."


'/>"/>
Contact: Katie Delach
katie.delach@uphs.upenn.edu
215-349-5964
University of Pennsylvania School of Medicine
Source:Eurekalert

Related medicine news :

1. Study: Mega Vitamins Wont Help After Heart Attack, Chelation Treatment Might
2. Study: Diabetic medication may protect patients from developing heart failure
3. Doctors Health Press Reports on German Study: Only 20% of Patients Get Colonoscopies, Important in Preventing and Diagnosing Colon Cancer
4. Bel Marra Health Reports on a New Study: Parents are Much More Likely to Experience Symptoms of Depression and Anxiety
5. Study: HPV Genital Warts is Most Common Sexually Transmitted Infection in U.S. Military, polyDNA Recommends Gene-Eden-VIR Against the HPV Infection
6. Study: Computerized reminders significantly improve HIV care in resource-limited setting
7. New gender benchmarking study: Brazil succeeding in providing a positive STI environment for women
8. Bel Marra Health Reports on a New Study: Software Originally Used for Star Gazing Now Being Used to Analyze Breast Cancer Tissue
9. Study: Same-sex cohabitors less healthy than those in heterosexual marriages
10. Doctors Health Press Reports on Study: Heart-Healthy Linoleic Acid Levels Decrease with Age
11. Study: Electronic Prescribing Cuts Medication Errors
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/13/2017)... ... October 13, 2017 , ... As health professionals work to improve their approach ... patient is doing more than filling out a survey; in many cases health professionals ... emphasis in health care and research on the importance of active engagement with patients ...
(Date:10/13/2017)... ... October 13, 2017 , ... ... ‘17, and Jennifer Huggins, PharmD ’17, along with clinical associate professor Janice ... of cardiovascular diseases during the 15th Annual Women’s Health Conference. The SIU ...
(Date:10/13/2017)... New York, NY (PRWEB) , ... October 13, 2017 , ... ... most influential people in business to advocate for action towards gender equality at their ... 18,000 views from around the globe, and reached a social audience of over 3 ...
(Date:10/13/2017)... ... 13, 2017 , ... “The Journey: From the Mountains to the Mission Field”: ... souls in the Philippines. “The Journey: From the Mountains to the Mission Field” is ... Bible. She has taught all ages and currently teaches a class of ladies at ...
(Date:10/12/2017)... , ... October 12, 2017 , ... ... to meet the demand of today’s consumer and regulatory authorities worldwide. From Children’s ... experts and tested to meet the highest standard. , These products are ...
Breaking Medicine News(10 mins):
(Date:10/2/2017)... Labs announces the European launch of their new low volume, high ... in Cambridge, U.K on October 4th. The ... with unprecedented speed and sensitivity while using far less sample volume ... ... ...
(Date:9/28/2017)... Sept. 28, 2017 Cohen Veterans Bioscience and ... use of wearable and home sensors for real-time monitoring ... Signal Foundation, a nonprofit organization focused on disruptive health ... an affordable analytical system to record and integrate behavioral, ... ...
(Date:9/25/2017)... --  Montrium , an industry leader in powerful ... Trial Master Files & Inspection Readiness Conference ( ... Services has selected eTMF Connect to ... a leading European contract research organization (CRO), will ... enable greater collaboration with sponsors, improve compliance and ...
Breaking Medicine Technology: