The Burrill Report


I am not afraid to admit that there are times when I feel a tad vulnerable. Near the top of that list, I would say without hesitation is during a prostate exam.

Fortunately my prostate is doing just fine these days, but I can only imagine the added feeling of vulnerability that comes when Doctor Feelgood tells you that your prostate is riddled with cancer. I’ve got strong feelings about my prostate. I’m quite fond of it. Frankly, if I trust a doctor enough to examine my prostate, I suspect I’m going to be pretty open to trusting his advice when it comes to telling me what I need to do to rid it of cancer.

A new report from the Government Accountability Office, though, should cause trusting prostate cancer patients to think twice about taking their doctors’ advice at face value. It found doctors that have a financial interest in radiation treatment centers are more likely to prescribe these expensive radiation therapies than other doctors.

The report comes as the debate over how to align physician incentives with payers and patients continues in the broader discussion of healthcare reform. It serves as an example of how financial interests can lead to greater costs in healthcare without necessarily leading to improved outcomes.

From 2006 through 2010, the number of prostate cancer-related intensity-modulated radiation therapy or IMRT services performed by self-referring doctor groups increased at an annual rate of 46 percent to 360,000 from 80,000, the GAO said. At the same time, the number performed by non-self-referring groups decreased at an annual rate of 1 percent to 466,000 from 490,000. IMRT is a form of external beam radiation therapy commonly used to treat prostate cancer. There are multiple, effective treatments for the disease, but the GAO notes IMRT is one of the costliest. In 2010, prostate-related IMRT services accounted for about 55 percent of the $1.2 billion that Medicare paid for all IMRT services under Medicare Part B.

What’s more, providers that switched from being non-self-referring to self-referring referred a greater percentage of their prostate cancer patients for IMRT after they began to self-refer. The number for these doctors grew to 54 percent from 37 percent after beginning to self-refer.

“Cancer patients should never have to question their doctors’ motives,” says Senate Finance Committee Chairman Max Baucus, D-Montana, one of the requestors of the report. “This is even more evidence that our healthcare system needs to reward the value of care, rather than the volume of treatments and procedures. Unfortunately, when you look at the numbers in this report, you start to wonder where health care stops and where profiteering begins.”

Both the American Urological Association and the Large Urology Group Practice Association criticized the report and disputed its findings. The American Urological Association said there was inadequate evidence to support the GAO’s linkage of financial incentives to an increase in IMRT among self-referring providers. The Large Urology Group Practice Association said the increase is explained by patient preference and an increase in the number of self-referring providers.

The GAO says Congress should consider directing the Secretary of Health and Human Services to require providers who self-refer IMRT services disclose to their patients that they have a financial interest in the service. It also recommends that CMS insert a self-referral flag on its Medicare Part B claims form, requiring that providers indicate whether the IMRT service for which a provider is billing Medicare is self-referred, and monitor the effects that self-referral has on costs and beneficiary treatment selection.

I’m willing to tolerate a lot at the urging of a doctor I trust. I’m willing to feel pokes, prods, and probes in my most intimate of areas. I’ve had cameras travel to where, as Captain Kirk would say, no man has gone before. Trust between a doctor and patient is essential and simple transparency can help maintain that trust. When it comes to trust, the one thing I don’t want when I leave my doctor’s office is to feel violated.



August 23, 2013
http://www.burrillreport.com/article-in_doctors_we_trust.html