A MUST read - 86 percent on some chemotherapy drugs. The doctors then pocketed the di
 

An interesting article with thought provoking potential consequences as part of the expanding numbers of increasingly expensive treatments, and apparent pricing on "worth" of drugs.

It also has consequences for insurance availability and cost.

It has potential consequences for the perception of the medical profession in the community. Could we see the same thought of cynicism creeping into medice that exists in politics - the best will and intentions (even if sometimes rendered ineffective by the "system") of the many poisoned in the minds of the public by the few.

RB



http://www.iht.com/articles/2006/03/...iness/sway.php

ABSTRACT

Study links cancer doctors' pay and their treatment
By Reed Abelson The New York Times

THURSDAY, MARCH 9, 2006
NEW YORK: The way cancer doctors are paid may influence the choice of drugs they use in chemotherapy, a study published Tuesday concluded.

Payment methods do not seem to affect whether doctors favor chemotherapy over other treatments, said the authors of the study, which covered only physicians in the United States. But once doctors decide to use chemotherapy, the current payment system appears to prompt some physicians 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, was 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, which is more expensive and less convenient to patients.

But some insurers, including Medicare, the U.S. government 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 Bailes, disputed the study's findings, saying that cancer doctors selected treatments on the basis of clinical evidence only.

"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 drugs, help address some of the concerns, he said.

Medicare also began a program this year in which oncologists are paid to report to 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 Bach, a senior official with Medicare.

The researchers looked at how much Medicare paid for different chemotherapy drugs and how 9,357 cancer patients older than 65 and 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 Newhouse, a professor of health policy and management at Harvard, said in an interview.

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 Earle, an associate professor of medicine at Harvard and an oncologist at the Dana- Farber Cancer Institute in Boston.


NEW YORK: The way cancer doctors are paid may influence the choice of drugs they use in chemotherapy, a study published Tuesday concluded.

Payment methods do not seem to affect whether doctors favor chemotherapy over other treatments, said the authors of the study, which covered only physicians in the United States. But once doctors decide to use chemotherapy, the current payment system appears to prompt some physicians 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, was 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, which is more expensive and less convenient to patients.

But some insurers, including Medicare, the U.S. government 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 Bailes, disputed the study's findings, saying that cancer doctors selected treatments on the basis of clinical evidence only.

"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 drugs, help address some of the concerns, he said.

Medicare also began a program this year in which oncologists are paid to report to 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 Bach, a senior official with Medicare.

The researchers looked at how much Medicare paid for different chemotherapy drugs and how 9,357 cancer patients older than 65 and 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 Newhouse, a professor of health policy and management at Harvard, said in an interview.

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 Earle, an associate professor of medicine at Harvard and an oncologist at the Dana- Farber Cancer Institute in Boston.

Cancer Drug Representatives Spelled Out the Way to Profit
 

“It's clear that physicians stopped making decisions based on what made scientific or clinical sense in lieu of what made better business sense”

Medicare's decision to reform the way it paid for cancer drugs came after a decade in which oncologists collectively made billions of dollars on the drugs they prescribed.

http://www.nytimes.com/2007/06/12/bu...l?ref=business

Selling cancer chemotherapy with concessions creates conflicts of interest for oncologists

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.

This was first brought to attention at a Medicare Advisory Panel meeting in 1999 in Baltimore. 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.

Typically, doctors give patients prescriptions for drugs that are then filled at pharmacies. But medical oncologists bought chemotherapy drugs themselves, often at prices discounted by drug manufacturers trying to sell more of their products and then administered them intravenously to patients in their offices.

Not only do the medical oncologists have complete logistical, administrative, marketing and financial control of the process, they also control the knowledge of the process. The result is that the medical oncologist selects the product, selects the vendor, decides the markup, conceals details of the transaction to the degree they wish, and delivers the product on their own terms including time, place and modality.

A joint Michigan/Harvard study authored by Drs. Joseph Newhouse and Craig C. Earle, entitled, "Does reimbursement influence chemotherapy treatment for cancer patients," confirmed that before the new Medicare reform, medical oncologists chose cancer chemotherapy based on how much money the chemotherapy earned the medical oncologist. 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.

A patient wants a physician's decision to be based on experience, clinical information, new basic science insights and the like, not on how much money the doctor gets to keep. A patient should know if there are any financial incentives at work in determining what cancer drugs are being prescribed.

It's not that all medical oncologists are bad people. It's just that the system is rotten and still an impossible conflict of interest. Some oncologists prescribe chemotherapy drugs with equal efficacies and toxicities. I would imagine that some are influenced by the whole state of affairs, possibly without even entirely admitting it. There are so many ways for humans to rationalize their behavior.

There is some innate goodness of people who go into oncology. At the time when most oncologists practicing today made the decision to become oncologists, there was no Chemotherapy Concession. Most of them probably had a personal life experience which created the calling to do battle against the great crab. At the time when people make their most important decisions in life, they are in the most idealitstic period of their lives.

The government wasn't reducing payment for cancer care under the new Medicare bill. They were simply reducing overpayment for chemotherapy drugs, and paying cancer specialists the same as other physicians. The government can't afford to overpay for drugs, in an era where all these new drugs are being introduced, which are fantastically expensive.

Although the new Medicare bill tried to curtail the Chemotherapy Concession, private insurers still go along with it. What needs to be done is to remove the profit incentive from the choice of drug treatments. Medical oncologists should be taken out of the retail pharmacy business and let them be doctors again.

http://www.healthyskepticism.org:80/news/2007/Jun.php

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Drug Companies
 

I would look to the Pharmeceutical Companies when you want to find corruption. The Oncologists aren't making the big money...the drug companies are. They are part of big government and they are to blame for the cost of drugs. Not the Oncologists....Love, Vickie

I have always suspected that oncologists are making excessive money in their office chemo settings. This is obviously an area FDA should investigate and police. Drug makers too should be held accountable for their reasonable profit and research.

thank you
 

Now I don't feel guilty for all the phone calls to my oncologist.

For the fee the doctors charges us, we shouldn't feel guilty in the first place. At most working places, do you feel remorse if your supervisor asks you to do a little extra? Don't lose the sight that a doctor is your employee and he or she is supposedly to perform. The type of work your employee is asked to do is irrelevant to the compensation.

Emerging data is showing that there is a continuing problem with the Chemotherapy Concession. A system which rewards medical oncologists for being pharmacists. The kaisernetwork.org's Daily Health Policy Report lists two recent New York Times articles that indicate this is precisely how chemotherapy drugs are being selected in the real world of cancer medicine. After the last seven years of investigating this myself, it doesn't really surprise me. But the lastest Times articles have surprised me!

Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs which they dispense in their offices as part of treatment. Doctors receive the rebates after they buy the drugs from the companies. But they also receive reimbursement from Medicare or private insurers for the drugs, often at a markup over the doctors' purchase price.

And the revelation about pharmaceutical companies calculating to the penny the profits that doctors could make from their drugs and sales reps from those companies shaing those profit estimates with doctors and their staffs. This information comes from industry documents that have become public in a federal civil lawsuit against the drug makers. This documents show that representatives for the companies actually brought spreadsheets to oncologists' offices to show doctors how much they could make.

Let's take medical oncologists out of the retail pharmacy business and let them be doctors again.

http://www.kaisernetwork.org:80/dail...fm?DR_ID=45527

http://www.healthyskepticism.org/news/2007/Jun.php