Food for thought--does payment method/type alter choice of chemotherapy drugs?

Pay Method Said to Sway Drug Choices of Oncologists [New York Times; Subscribe]
The way cancer doctors are paid may influence the choice of drugs they use in chemotherapy, a study published yesterday has concluded.

Payment methods do not seem to affect whether doctors favor chemotherapy over other treatments, the study's authors said. But once they decide to use chemotherapy, the current payment system appears to prompt some doctors 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, is 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 rather than in a hospital, which is more expensive and less convenient to patients. But some insurers, including Medicare, the federal 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 S. Bailes, disputed the study's findings, saying that cancer doctors select treatments only on the basis of clinical evidence. "All of us are looking at clinical trials," he said.

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ABSTRACT: Does Reimbursement Influence Chemotherapy Treatment For Cancer Patients? [Health Affairs; Subscribe]
Before the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, Medicare reimbursed physicians for chemotherapy drugs at rates that greatly exceeded physicians' costs for those drugs. We examined the effect of physician reimbursement on chemotherapy treatment of Medicare beneficiaries older than age sixty-five with metastatic lung, breast, colorectal, or other gastrointestinal cancers between 1995 and 1998 (9,357 patients). A physician's decision to administer chemotherapy to metastatic cancer patients was not measurably affected by higher reimbursement. Providers who were more generously reimbursed, however, prescribed more-costly chemotherapy regimens to metastatic breast, colorectal, and lung cancer patients.