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Study shows drop in unnecessary care after Medicare reimbursement cut
Date:11/3/2010

ANN ARBOR, Mich. When Medicare policy changes led to reductions in reimbursement for hormonal treatment of prostate cancer, there was a sharp decline in its use among patients not likely to benefit from the treatment. But among patients for whom the therapy is clearly beneficial, doctors continued to prescribe it at the same rate, according to a new study.

This finding suggests that financial reform of health care can reduce unnecessary care without impacting care to those patients most likely to benefit from a treatment.

"We found that physicians respond to reimbursement, but they respond in a way that appears to be beneficial to the patient. They don't tend to cut out necessary care, but they tend to cut out unnecessary or inappropriate care. This suggests cutting reimbursements in the right context can help reduce unnecessary care," says lead study author Vahakn B. Shahinian, M.D., M.S., assistant professor of internal medicine at the University of Michigan Medical School and a member of the U-M Comprehensive Cancer Center.

Results of the study appear Nov. 4 in the New England Journal of Medicine.

The researchers looked at use of androgen deprivation therapy, a common type of treatment for prostate cancer that involves blocking the male hormone testosterone through a regular injection. Clinical trials have shown clear benefit for men with high-risk tumors who receive this treatment along with radiation therapy. But the benefit is less clear when androgen deprivation therapy is used by itself in lower risk tumors.

Through the 1990s, Medicare reimbursement for this therapy was set at 95 percent of the average wholesale price of the drug. The average practice got the drug for 82 percent of wholesale, which allowed for large profits by many practices. Use of androgen deprivation therapy grew until half-million men were receiving it at its peak, with more than $1 billion in Medicare expenditures.

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Contact: Nicole Fawcett
nfawcett@umich.edu
734-764-2220
University of Michigan Health System
Source:Eurekalert

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