Posted on 02/08/2010 4:59:48 PM PST by decimon
ATLANTA-Feb. 8, 2009-Increased Medicare payments to physicians for outpatient surgeries for bladder cancer have led to a dramatic rise in the number of these procedures being performed and an overall increase in cost to the healthcare system. That is the conclusion of a new study published early online in Cancer, a peer-reviewed journal of the American Cancer Society. The findings indicate that some Medicare policies aimed at decreasing costs may instead be contributing to an increase in healthcare expenditures.
Because bladder cancer is the most expensive cancer to treat, its management places a significant economic burden on the United States healthcare system, which costs two to four times that of healthcare systems in any other industrialized nation. In an attempt to reduce costs, in 2005 Medicare increased physician reimbursement for office-based endoscopic bladder procedures, such as biopsies. Moving these procedures from the more expensive inpatient hospital setting to the presumably less expensive outpatient office setting could cut costs provided that they are performed for the same indications, are equally efficacious, and are tolerable to patients.
The reimbursement change was expected to alter physician incentives, leading to increased use of outpatient endoscopic surgery, a decline in hospital-based endoscopic surgery and, consequently, a reduction in healthcare-related costs. To evaluate this hypothesis, Micah Hemani, MD, and Samir Taneja, MD, of the Division of Urologic Oncology at the New York University Langone Medical Center and their colleagues assessed treatment patterns in their practice before and after the Medicare change in physician reimbursement.
The investigators found that the number of outpatient bladder surgeries doubled after Medicare reimbursements rose, but the number of hospital-based surgeries did not significantly decline. As a result, there was a 50% increase in overall Medicare costs. While there was an increase in patient referrals for outpatient surgeries, it was not sufficient enough to account for the increased use of these procedures. There was, however, a rise in the redundant use of outpatient surgery on patients who also underwent hospital-based surgery for the same condition. Also, while the number of outpatient procedures increased, the likelihood that a procedure would lead to a bladder cancer diagnosis declined. "We believe these trends are disturbing as they may reflect both diagnostic and therapeutic over-utilization of office-based endoscopic bladder surgery," the authors wrote.
The reasons for this surge in use of outpatient procedures are unknown but might include improvements in office-based equipment for surgery, improved physician comfort and skill with these operations, and the incentive of receiving increased financial reimbursement. Whatever the cause, these findings suggest that Medicare financial incentives for the outpatient treatment of bladder cancer may actually increase overall costs without improving care.
Dr. Hemani noted that the study's results illustrate a need for clinical guidelines for these office-based surgeries, as well as a need for policy measures that ensure accountability for physicians who perform them.
"Given the ongoing healthcare debate in Congress regarding reforming the current system, one wonders if many of the changes currently being proposed in Washington might not have similar effects to what we are seeing in this one isolated example," said David Penson, MD, MPH, of Vanderbilt University in Nashville, who was not involved with the study but wrote an accompanying editorial. "Sometimes, policies have the exact opposite effect of what was intended," he cautioned.
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Articles: "The effect of changes in Medicare reimbursement on the practice of office and hospital-based endoscopic surgery for bladder cancer." Micah Hemani, Danil Makarov, William Huang, and Samir Taneja. Cancer; Published Online: February 8, 2010 (DOI: 10.1002/cncr.24875). "Medicare reimbursement changes for bladder biopsies: a cautionary tale of unintended consequences." David Penson. Cancer; Published Online: February 8, 2010 (DOI: 10.1002/cncr.24881).
Cut it out ping.
...but you listen to Jack Squat and his minion of economist idiots, passing comprehensive healthcare will save this country trillions and help with the deficit...
Btw, Social Security, another huge arse government run program bit the “in-the-red” bullet today......how frakin quain these IDIOTS think they can do anything right with our money while saving us money! lolz...=.= !
Tennessee has joined several other states in trying to pass a Health Care Freedom Act. NO COLAs for granny, retired Military or retired fed employees. BIG NEW fees for Tricare for Life retired over 65 Military's secondary health ins. (DOD bill already passed, delayed but goes into effect 2011)
New Dem mantra: Woof, woof eat dog food granny....ala let them eat cake.
He was a big dog Democrat ~ LBJ's VP in fact. He was also personally courageous even if his politics were maudlin and silly.
He developed bladder cancer. He placed himself at the mercies of the doctors to do experimental surgery or treat him with chemicals, or whatever else they wanted to do.
I note this because it will give everybody a time-frame to consider the difference between bladder cancer treatment "then" and the current use of outpatient endoscopic surgical techniques.
I'm sure The Hump would have considered this sort of thing akin to magic.
"Magic" costs lots of money.
The Obamacare plan for dealing with the high costs of cancer treatment appears to be to simply not offer it.
Does anyone see the difference between the Democrats of 30 years ago and today's pretenders?
I thought so.
I do. Jimmy Carter remembers Hubert Horatio Hornblower.
Does anyone see the difference between the Democrats of 30 years ago and today's pretenders?
Point taken but I believe Humphrey was in favor of such programs.
On the other hand he did think dealing with cancer was worth the effort ~ which is the point I was making ~ that today's Democrats don't think it's worth the effort to treat cancer.
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