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Study: Docs More Likely to Recommend Costly Prostate Therapy When They Own the Machine

Federal law allows ‘in house’ services (October 24)

According to a new study in the New England Journal of Medicine, doctors who stand to profit from an expensive form of prostate cancer treatment — intensity-modulated radiation therapy (IMRT) — are twice as likely to recommend it, even though there is no definitive evidence that it is better than other treatments.

IMRT typically costs more than $31,000, while options costing about half that, or less, are available.

Using Medicare claims from 2005 through 2010, Jean M. Mitchell, PhD, a researcher at Georgetown University, examined the association between ownership of IMRT services and the use of IMRT to treat prostate cancer.

She found that the rate of IMRT use by self-referring urologists in private practice increased from 13.1% to 32.3% — an increase of 19.2 percentage points (P < 0.001). In comparison, the rate of IMRT use increased from 14.3% to 15.6% — an increase of 1.3 percentage points (P = 0.05). In addition, the rate of IMRT use by urologists working at National Comprehensive Cancer Network centers remained stable at 8.0% but increased by 33.0 percentage points among 11 matched self-referring urology groups. The regression-adjusted difference-in-differences effect was 29.3 percentage points (P < 0.001).

Mitchell concluded that urologists who acquired ownership of IMRT services increased their use of IMRT substantially more than urologists who did not own such services. Allowing urologists to self-refer for IMRT may contribute to increased use of this expensive therapy, she noted.

Federal law prohibits self-referral — when doctors send patients for tests or treatment from which the physician stands to gain financially — but makes an exception for “in house” services, such as IMRT.

Sources: NEJM; October 24, 2013; and Reuters; October 24, 2013.

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