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Use of Prostate Cancer Treatment Fell When Medicare Paid Docs Less
Date:11/3/2010

By Amanda Gardner
HealthDay Reporter

WEDNESDAY, Nov. 3 (HealthDay News) -- When Medicare cut its reimbursement rates for hormonal treatment for men with prostate cancer, use declined drastically.

But patients who really stood to benefit from the treatment -- androgen-deprivation therapy -- still received it, researchers report in the Nov. 4 issue of the New England Journal of Medicine.

"Probably what we're witnessing here is how physicians potentially respond to financial incentives and issues of medical uncertainty," said study author Dr. Vahakn Bedig Shahinian, an assistant professor of internal medicine at the University of Michigan, in Ann Arbor. "That probably cuts across a variety of medical scenarios having nothing to do with prostate cancer."

Other experts agreed.

"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 c
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