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  1. More emphasis should be placed on prevention in healthcare. Medical students across the country have recently founded a new national health education program called Music Inspires Health. The innovative health education campaign is aimed at adolescents, college students, and young adults.
    We are creating entertaining health education short films, an innovative website, and launching health education events for young people across the country.
    If you are interested in making a financial contribution, please go to the website: http://musicinspireshealth.chipin.com/music-inspires-health

  2. Approach to Healthcare policy reform and improvement is not getting any easier for the patients or health providers. No one person in government, insurance health organization can come up with an easy “quick fix” solution in the U.S..
    Brian Kleppers attmept to illustrate the mess in oncology called The cognitive dissonance of conflicted care is greatly appreciate.

  3. About 30 years ago I read a book titled, “The Politics of Cancer” by Samuel Epstein, MD. The book said the contraction, prevention, and treatment of cancer was primarily a political creation of business and government. He could now write an addendum to the book called, “The Profits Of Cancer”. I think both the politics and profits involved are closely tied to the maintenance of this disease.

  4. This issue first came to light in testimony at a Medicare Executive Committee meeting in Baltimore, Maryland in December 1999. There was a gastroenterologist in attendance who complained that Medicare had cut his reimbursement for colonoscopies from $400 to $108 and how all the doctors in his large, multi-specialty internal medicine group were hurting, save for two medical oncologists, whom he said were making a killing running their in-office retail pharmacies.
    Over the last seven years, the New York Times has been on this topic like white on rice, as Brian describes. There was a NYT article in early 2000 that stated President Clinton was attempting to change the reimbursement practices. Then there was another NYT article in January of 2003 that got some needed public scrutiny. CMS was going to force steep reductions in Medicare drug reimbursement to oncologists for chemotherapy infusion procedures. That triggered Congress to act with pressure from some cancer doctors. What resulted was the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003, signed in December of that year.
    The NYT issues addressed one of the biggest concerns about cancer care in the community hospital setting. The shift, more than 20 years ago, from the institution-based, inpatient setting to community-based, ambulatory sites for treating the majority of the nation’s cancer patients has prompted in large part additional costs to the government and Medicare beneficiaries. The Chemotherapy Concession gave oncologists the financial incentive to select certain forms of chemotherapy over others because they receive higher reimbursement.
    In March 2004, the editorial board of the New York Times criticized “angry doctors” for terrorizing their patients into believing that a reformed Medicare drug reimbursement plan would force them to turn cancer patients out to less convenient and less comfortable hospitals for chemotherapy treatment. Of course it did bring about many new hospital building projects – “Milking Medicare” – to house these new community cancer centers, much like the new orthopedic and cardio projects.
    In March 2006, New York Times described the published joint Harvard/Michigan study in the journal Health Affairs. The authors of the study documented a clear association between reimbursement to the oncologists for the chemotherapy of breast, lung, and colorectal cancer and the regimens which the oncologists selected for the patients. In other words, oncologists tended to base their treatment decisions on which regimen provided the greatest financial remuneration to the oncologist.
    While the Harvard/Michigan study documented what happen before the new Medicare law, a survey by Dr. Neil Love, “Patterns of Care,” showed results that the Medicare reforms still were not working. It was still an impossible conflict of interest.
    With the lastest New York Times articles exploring the deep financial conflicts in oncology drug prescribing, as Brian states, even though Medicare has limited the profits of oncologists who prescribe drugs, Medicare’s total cancer care expenditures keep rising because oncologists have found new treatments and procedures to bill for. And the rules guiding Medicare reimbursement for cancer and drug rebates are complex, resulting in patients often receiving more costly drugs.
    A precursor to the modern Chemotherapy Concession going on in the United States had been forbidden in Germany since the 13th century, as a result of a very visionary German ruler, Frederick II of Hohenstaufen, Emperor of the Holy Roman Empire of the Germanic Nation, and his visionary law (Edict of Salerno) regarding the separation of the professions of Physician and Pharmacist.
    His 1241 Edict of Salerno (sometimes called Constitution of Salerno) made the first legally fixed separation of the occupations of physician and apothecary. Physicians were forbidden to double as pharmacists and the prices of various medicinal remedies were fixed. This became a model for regulation of the practice of pharmacy throughout Europe.
    Medical oncologists should be taken out of the retail pharmacy business and let them be doctors again.

  5. Good article. My two takeaways from the article, which also apply to all other financial arrangements in healthcare and elsewhere are: (1) incentives matter, and (2) beware of unintended (and unwanted) consequences. As policymakers contemplate changes to our healthcare system, hopefully, they will take those two fundamental economic principles into consideration.