Doctors with a financial interest in radiation treatment centers tend to be likelier to prescribe related therapies for their patients diagnosed with prostate cancer.
A new report issued by Congressional investigators from the Government Accountability Office (GAO), indicated that Medicare beneficiaries did not always know that their physicians were potentially profiting from use of the therapy. According to the report, wrote The New York Times, other treatments might be as effective and less costly for Medicare and beneficiaries.
The auditors also found that other, recent research revealed a similar pattern of use when physicians owned laboratories and imaging centers that also billed Medicare for CT scanning and magnetic resonance imaging (MRI), according to the Times.
This recent study looked specifically at intensity-modulated radiation therapy, a prostate cancer treatment that directs radiation beams at cancer tumors, the Times explained. Often, the physician recommending treatment also had a financial relationship with providers. James C. Cosgrove, a director of the health care team at the Government Accountability Office, told the Times that “financial incentives” seemed to be a factor in the increased use of this particular radiation therapy for prostate cancer.
In fact, according to the report, urologists “referred a substantially higher percentage of their prostate cancer patients” to this type of radiation therapy when they owned the equipment involved, known as linear accelerators, or when they had financial connections to treatment providers, according to the Times.
“When you look at the numbers in this report, you start to wonder where health care stops and profiteering begins,” said Senator Max Baucus (Democrat-Montana), 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,” he added, the Times reported. “This analysis confirms that financial incentives, not patients’ needs, are driving some referral patterns,” said Representative Sander M. Levin (Michigan), senior Democrat on the Ways and Means Committee, the Times noted.
“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, chairman of radiation oncology at the UCLA medical school, according to the Times.
As we’ve long stressed, financial relationships between industry and health care have provoked enormous controversy. Critics argue that these relationships create conflicts of interest that could unduly impact research findings and prescribing practices, creating a situation in which patients are no longer the primary focus in health care decisions. Meanwhile, device and drug makers continue to market their products using promotional strategies that encourage so-called “consultative” relationships with physicians. In these relationships, doctors are brought back and paid to use industry’s products and promote them to their colleagues.
In a related matter, we recently wrote that Physician-Owned Distributorships (PODs), which have been created in least 20 states, just garnered the attention of a government watchdog group, which issued an alert over fraud risks associated with the controversial entities. The deals surgeons make with these PODs have prompted a Department of Justice (DOJ) investigation over the influence these entities have over hospital purchasing practices.
In a PODs arrangement, physicians purchase ownership interests in the medical device distributor and share in the profits PODs make through sales to hospitals.
The Office of Inspector General recently issued a warning over fraud risks tied to PODs. In its report, the Office indicated that its longstanding guidance “makes clear that the opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, could constitute illegal remuneration under the anti-kickback statute,” according to a prior Reuters report. “The anti-kickback statute is violated if even one purpose of the remuneration is to induce such referrals” by healthcare professionals involved in PODs, the report indicated. The language in the report “can’t get any more damning,” Dr. Josh Jennings, an analyst with Cowen & Co, told Reuters.