[gdpawel]

Jennifer L. Malin, Jane C. Weeks, Arnold L. Potosky, Mark C. Hornbrook and Nancy L. Keating

Jennifer L. Malin, Jonsson Comprehensive Cancer Center and David Geffen School of Medicine at University of California at Los Angeles and Greater Los Angeles VA Healthcare System, Los Angeles, CA; Jane C. Weeks, Dana-Farber Cancer Institute; Nancy L. Keating, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Arnold L. Potosky, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; and Mark C. Hornbrook, Center for Health Research, Kaiser Permanente Northwest, Portland, OR.

Corresponding author: Jennifer L. Malin, MD, PhD, WellPoint, 1 WellPoint Way, Thousand Oaks, CA 91362; e-mail: [email]jennifer.malin@wellpoint.com

Abstract

Purpose:

The cost of cancer care continues to increase at an unprecedented rate. Concerns have been raised about financial incentives associated with the chemotherapy concession in oncology practices and their impact on treatment recommendations.

Methods:

The objective of this study was to measure the physician-reported effects of prescribing chemotherapy or growth factors or making referrals to other cancer specialists, hospice, or hospital admissions on medical oncologists' income. US medical oncologists involved in the care of a population-based cohort of patients with lung or colorectal cancer from the Cancer Care Outcomes Research and Surveillance (CanCORS) study were surveyed regarding their perceptions of the impact of prescribing practices or referrals on their income.

Results:

Although most oncologists reported that their incomes would be unaffected, compared with salaried oncologists, physicians in fee-for-service practice, and those paid a salary with productivity incentives were more likely to report that their income would increase from administering chemotherapy (odds ratios [ORs], 7.05 and 7.52, respectively; both P < .001) or administering growth factors (ORs, 5.60 and 6.03, respectively; both P < .001).

Conclusion:

A substantial proportion of oncologists who are not paid a fixed salary report that their incomes increase when they administer chemotherapy and growth factors. Further research is needed to understand the impact of these financial incentives on both the quality and cost of care.

The Medical Oncologist

http://cancerfocus.org/forum/showthread.php?t=3395

It is more than just 'perceptions' that medical oncologists are influence by financial chemotherapy concessions.

If anybody understands the politics of the 'chemotherapy concession,' you'll understand it is a shameless way to preserve a system which presents an impossible conflict of interest for both cancer centers and treating oncologists. A system in which there is a financial incentive to select certain forms of chemotherapy over certain others because they receive higher reimbursement.

Not the least of the problems is that this inherently corrupt system provides a strong 'disincentive' to individualize or tailor therapy, based on laboratory testing, because such individualized treatment removes the oncologist's 'freedom to choose' from between a large number of different possible drug regimens, with wildly differing profit margins.

What is needed is to remove the profit incentive from the choice of cancer treatments. Patients should receive what is best for them and not what is best for their oncologists. It amazes me that private insurance carriers do not like to pay for assays but they don't emphatically mandate it as a requirement for obtaining chemotherapy reimbursement against "ill-directed" treatment.

Evidence in support of these assays is more than sufficient to justify them. But 'profit' is a powerful motivating force. Among the private payers at least, the profit motive is entirely consistent with the goal of the assays, which is to identify efficacious therapies irrespective of drug mark-up rates.