Physicians

PHYSICIANS/POLICY: NY Times is surprised about its Ps and Qs in Prostate Cancer Therapy

Das KapitalSo there are three treatments for prostate cancer. Medicare pays physicians a whole lot more for one (new snazzy non-invasive one that patients prefer too)  than the other two. So they rush off to get the necessary equipment and staff-up to perform the new procedure. Then they start doing that rather more than they others. And the NY Times is surprised!

Wow. Just wait till they hear about chemotherapy, and how much of that treatment “choice” is based on incentives to physicians. (Cue Greg to tell us!)

Just another reminder why non-globally budgeted FFS in a system with no mandated technology cost-effectiveness assessment does not work. And that’s roughly what Medicare provides. Instead we should be trying to figure out what is the best patient long-term outcome is for a pre-determined amount of spending.

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aDanJakeGreg Pawelskijd Recent comment authors
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a
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a

Why is it shocking to everyone that when there is an opportunity to legally increase monetary income, smart people find a way to do it, full speed ahead. ASTRO knows that urologists were furious about losing turf to radiation, but seeds became the middle ground. Then when hospitals began screwing doctors left and right, docs realized if they banded together, they could take over profitable outpatient based care. Now, the urologists ironically are going to hose over radoncs, but in truth, they cannot do it without radoncs who work with them. Those who go with uro-rad may or may not… Read more »

Dan
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Dan

I agree that patient choice plays a large role in the ultimate treatment decision. However, as a Rad Onc I have seen first hand hoe this works. When I started in practice the only referals I received from urologists were patients too risky for radical surgery. The urologists then set up an outpatient center in which they could collect the technical component from a seed implant and all of the sudden the patients that were refered to me “wanted” a seed implant. They were told how much better that was than IMRT by the urologists. Now that they have figured… Read more »

pgbMD
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pgbMD

Actually it has been a republican controlled Congress for longer than 6 years. I am sure they will try to do quite a bit of accommodating and the first order of business will be to raise taxes on all those rich people making over $75k per year. We will see.

Greg Pawelski
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Greg Pawelski

After the last six years, perhaps the new Congress will finally try to accommodate?

pgbMD
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pgbMD

“Could it be that a certain negative bias is directed at the NYT because of its critical articles about the Bush Administration and their war in Iraq? Which by the way are proving correct.” I read the NYT eventhough it has a leftward tilt. I don’t believe I have bashed it here. “The ideal would be if patients received their treatment modality at some treatment center which wasn’t involved in the decision to treat or not to treat and in which the physician didn’t have a financial interest.” That was tried in the past but the laws were relaxed. It… Read more »

Greg Pawelski
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Greg Pawelski

It is illegal for physicians to refer patients for laboratory studies to centers in which they hold a financial interest. This is a sensible regulation against self-referral for perhaps unnecessary services which remunerate the referring physician, who then becomes the providing physician. The ideal would be if patients received their treatment modality at some treatment center which wasn’t involved in the decision to treat or not to treat and in which the physician didn’t have a financial interest.

Peter
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Peter

Well pgbMD I actually went to and read your link to the article in Oncology Times. Be careful what you wish for. It shows that the New York Times Article got it right. In fact the NYT was quite a wimp at reporting this issue compared to the Oncology Times Article. Could it be that a certain negative bias is directed at the NYT because of its critical articles about the Bush Administration and their war in Iraq? Which by the way are proving correct. I’ve taken a few pieces out of the OC Times article that bring out the… Read more »

pgbMD
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pgbMD
Jake
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Jake

Once again the New York Times gets the story completely wrong. The total bill for prostate surgery is over $80,000 when the cost of dealing with the horrendous side effects of surgery is taken into account. Prostate surgery is one of the most difficult procedures there is to perform. The prostate is buried deep within the body so the surgeon has to perform the surgery by feel. It does not help that the whole area is flooded with blood. It is not surprising that incontinence and impotence are common side effects of the surgery. The best surgeons have a 90%… Read more »

Greg Pawelski
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Greg Pawelski

In regards to the NYT article and prostate cancer in general, prostate cancer is a black hole. The problem is PSA testing. Prostate cancer is common. Wouldn’t surprise me one bit to learn I have a few prostate cancer cells lurking within. Would I get a radical prostatectomy were this diagnosed? No. Would I get radiotherapy? Probably not. PSA testing is a bonanza for urologists. Lots more prostate cancer gets diagnosed. They get to do lots more I.M.R.T.’s. Would these people have died of prostate cancer without the procedure? I doubt it.

pgbMD
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pgbMD

“I don’t think Dr. Glatstein’s comment was self serving.” Of course his comment was self serving. This is a good old fashioned urology/radiation oncology turf battle and the urologists will win because they own the patients. Don’t be fooled, I am sure Dr Glatstein is quietly purchasing an IMRT at this very moment. “take the financial incentive out of decisions and you have a good chance of a better decision.” To the contrary, investment in technology and competition in medicine leads to more choices, less invasive treatment options, more rapid deployment of newer technology, and ultimately a more informed treatment… Read more »

Peter
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Peter

pgbMD, I don’t think Dr. Glatstein’s comment was self serving. He can certainly buy the latest and greatest new Tech and cash in himself. I think his point of docs having a vested interest in performing certain procedures is key here. As in politics, take the financial incentive out of decisions and you have a good chance of a better decision. Should docs have to devulge their financial interest as stock brokers do? As to those “informed prostate cancer patients”, I think they have information not education. If they presented themslves in your office demanding you sacrifice a chicken to… Read more »

Eric
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Eric

Dear JD: The Commonwealth Fund study addressed efficiency in terms of per-capita payments, not in terms of administrative overhead. While I agree that Medicare has lower administrative overhead than private plans, the crucial policy question is whether the sum of administrative overhead + provider payments is greater in public programs or private programs. I don’t have enough space here to effectively discuss that issue, but I do urge you to look up a Health Affairs article written by James C. Robinson about 8 to 10 years ago, in which he debunks some of the more simplistic notions that proponents of… Read more »

Eric
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Eric

Just to clarify, my previous post on was not an argument in favor of defined contribution health plans or any other mechanism for shifting more financial risk to patients. What bothers me about the recently released Commonwealth Fund study is that the authors conclude the Medicare’s administered fee-for-service (FFS) pricing system is superior (in terms of “efficiency”) than Medicare’s HMO pricing system, yet they refuse to acknowledge the perverse impacts on quality of care which can result from the Medicare FFS system. Medicare’s reimbursement policies for oncology care are among the most egregious in the health insurance industry—while I am… Read more »

jd
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jd

Eric, You missed the point. Claims about the superior efficiency of Medicare over private commercial insurance don’t have anything to do with the fee schedule. “Efficiency” refers to administration, and it is here that Medicare has an advantage over private plans. Medicare pays almost nothing for sales and marketing, pays no stock options to CEOs, operates on a vast scale, does no underwriting, etc. Medicare Advantage plans will always be more expensive administratively than traditional Medicare, and small private insurers who spend 25% of SG&A on commisions and marketing will likewise be at a disadvantage to a government system like… Read more »