WASHINGTON — Doctors who have a financial interest in radiation treatment centers are much more likely to prescribe such treatments for patients with prostate cancer, Congressional investigators say in a new report.
The investigators, from the Government Accountability Office, said that Medicare beneficiaries were often unaware that their doctors stood to profit from the use of radiation therapy. Alternative treatments may be equally effective and are less expensive for Medicare and for beneficiaries, the report said. In other recent studies, the auditors found a similar pattern when doctors owned laboratories and imaging centers that billed Medicare for CT scans and magnetic resonance imaging.
The latest study focused on a common and costly treatment for prostate cancer known as intensity-modulated radiation therapy, which directs highly concentrated beams of radiation at cancerous tumors. In many cases, it said, doctors who recommend the treatment have financial relationships with those who provide it. For example, a group of urologists may own radiation therapy equipment that is used by other doctors in the same medical group to treat patients.
James C. Cosgrove, a director of the health care team at the Government Accountability Office, said that “financial incentives” appeared to be contributing to the higher use of this type of radiation therapy for patients with prostate cancer, one of the most common cancers in men.
Urologists “referred a substantially higher percentage of their prostate cancer patients” to radiation therapy when the doctors owned the equipment — linear accelerators — or had financial ties to those who provided the treatment, the report said.
The report comes as Congress is looking for ways to save money in Medicare and to make fundamental changes in the formula used to calculate payments to doctors treating Medicare patients.
“When you look at the numbers in this report, you start to wonder where health care stops and profiteering begins,” said Senator Max Baucus, a Montana Democrat who is the chairman of the Senate Finance Committee. “We have a law on the books designed to prevent these conflicts of interest, but an increasing number of physicians are skirting the law for personal gain.”
Representative Sander M. Levin of Michigan, the senior Democrat on the Ways and Means Committee, said that “this analysis confirms that financial incentives, not patients’ needs, are driving some referral patterns.”
The investigators said Medicare had no easy way to know when doctors referred patients to entities in which the doctors had financial interests. Doctors should be required to note such relationships on the claims they file with Medicare, the report said.
The Obama administration disagreed with this recommendation. Such a requirement, it said, would be “complex to administer and may have unintended consequences.” In his 2014 budget, Mr. Obama did propose new restrictions on doctors’ ability to refer patients for radiation therapy and certain other treatments in which the doctors have a financial interest.
Some doctors, including urologists, took issue with the study.
Dr. Deepak A. Kapoor, the president of the Large Urology Group Practice Association, which represents 2,200 urologists, said, “The G.A.O. greatly overstated the role of financial motives in treatment decisions and understated the importance of patients’ wanting to have their treatment in the offices of doctors who specialize in prostate cancer.”
Moreover, Dr. Kapoor said, “Prostate cancer treatments are shifting from hospitals to physician offices, where they cost less for patients and for the Medicare program.”
But other doctors applauded the report. Dr. Michael L. Steinberg, the chairman of the American Society for Radiation Oncology, which represents more than 5,000 doctors, said, “We are extremely concerned that many older male patients are receiving possibly unnecessary treatment by urology groups.”
“Some physician groups are steering patients to the most lucrative treatment they offer, depriving patients of the full range of treatment choices, including potentially no treatment at all,” said Dr. Steinberg, who is the chairman of radiation oncology at the U.C.L.A. medical school.
Written by Robert Pear and published on The New York Times, August 18, 2013.
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