Healthy Skepticism Library item: 3854

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Abelson R.
Pay Method Said to Sway Drug Choices of Oncologists
New York Times 2006 Mar 8
http://www.nytimes.com/2006/03/08/health/08docs.html?_r=1&oref=slogin

Notes:

Ralph Faggotter’s Comments:

“ Unlike other physicians, a cancer doctor can profit from the sale of chemotherapy drugs in a practice known as the chemotherapy concession. “

This sounds to me like a recipe for poor decision-making.
How can it be in the best interests of the patients?

Full text:

March 8, 2006
Pay Method Said to Sway Drug Choices of Oncologists
By REED ABELSON
New York Times

The way cancer doctors are paid may influence the choice of drugs they
use in chemotherapy, a study published yesterday has concluded.

Payment methods do not seem to affect whether doctors favor chemotherapy
over other treatments, the study authors said. But once they decide to
use chemotherapy, the current payment system appears to prompt some
doctors to use more expensive drugs, the study found.

“Providers who were more generously reimbursed,” the authors wrote,
“prescribed more costly chemotherapy regimens to metastatic breast,
colorectal and lung cancer patients.” The study, by researchers from the
University of Michigan and Harvard University, is published in the
current issue of the academic journal Health Affairs.

Unlike other physicians, a cancer doctor can profit from the sale of
chemotherapy drugs in a practice known as the chemotherapy concession.
These doctors are paid for the cost of the chemotherapy drugs given
intravenously in their offices – even though they frequently purchase
the drugs at lower prices than the amounts they are paid in insurance
reimbursements.

One government study said that cancer doctors, or oncologists, were
receiving discounts as high as 86 percent on some chemotherapy drugs.
The doctors then pocketed the difference.

While critics say this creates a potential conflict of interest among
oncologists advising patients on treatment, the doctors have said the
profit is needed to pay the high cost of running their practices. They
also have said the revenue allows patients to be treated in their
offices rather than in a hospital, which is more expensive and less
convenient to patients. But some insurers, including Medicare, the
federal insurance program for the elderly, have tried to change the way
they pay doctors to reduce their profit from the sale of chemotherapy drugs.

An executive with the American Society of Clinical Oncology, Dr. Joseph
S. Bailes, disputed the study’s findings, saying that cancer doctors
select treatments only on the basis of clinical evidence. “All of us are
looking at clinical trials,” he said.

Recent changes in the Medicare reimbursement system, aimed at paying
doctors more for the services they provide and less for the drugs, help
address some of the concerns, he said. Medicare also began a program
this year in which oncologists are paid simply to tell Medicare about
the treatments they are choosing. “What we’re trying to do is to
increasingly pay for quality, not just services,” said Dr. Peter B.
Bach, a senior official with Medicare.

The researchers looked at how much Medicare paid for different
chemotherapy drugs and how 9,357 cancer patients over 65 years old in
late stages of the disease were treated from 1995 to 1998. The
researchers focused on the treatment of metastatic cancer, or cancer
that has spread in the body, because they said doctors had the most
discretion in treating patients in advanced stages of the disease and in
prescribing chemotherapy treatments.

Because there is little evidence that one chemotherapy drug works better
than another, “the physicians have more control over the agents chosen,”
one of the authors, Joseph P. Newhouse, a professor of health policy and
management at Harvard, said in an interview.

Dr. Bailes disagreed. He said there was clear clinical evidence about
which drugs should be used even in advanced stages of the disease and
that doctors recommended the most appropriate treatments.

Doctors, despite their insistence that their treatment decisions are
based solely on what is best for the patient, are affected by payment
policies and other financial influences, including gifts from drug
companies, said another of the study’s authors, Dr. Craig C. Earle, an
associate professor of medicine at Harvard and an oncologist at the
Dana-Farber Cancer Institute in Boston. “When people look for
correlations, it really does affect what we do,” he said.