Urologist Owned Radiation Facility (IMRT) = Expensive Conflict of Interest

WSJ notes the overuse of IMRT (intensity modulated ratiation therapy) at great cost to patients, medicare, other insurers and our health care non-system.

In recent years a number of urology groups have puchased and own radiation centers. The result is costly self referrals and obvious conflicts of interest. Here’s how it works.

urologists buy radiation equipment and hire radiation oncologists to administer it. They then refer their patients to their in-house staff for treatment. The bulk of Medicare’s reimbursements goes to the urologists as owners of the equipment.

The problem is not patient outcomes or fewer complications but rather overuse of an effective form of treatment to the financial benefit of the providers.

Asked during the interview what proportion of its prostate-cancer patients Integrated Medical treats with IMRT, Dr. Kapoor said he didn’t track such data closely, but said he would be “comfortable” with an estimate of “one out of six,” or 17%.

An analysis of Integrated Medical’s Medicare claims later performed for the Journal suggested a much higher rate. Between its launch in mid-2006 and the end of 2008, Integrated Medical administered IMRT to 601, or 53%, of 1,132 Medicare patients recently diagnosed with prostate cancer, the Journal analysis found.

Integrated Medical received $26.7 million from Medicare for the care of those 601 patients, according to the Journal’s calculations. If Integrated Medical’s urologists hadn’t owned radiation equipment and had referred these patients for radiation treatment outside of their practice, Medicare would have paid them only $2.6 million. Medicynical note: The data on treatment of patients over 80 discussed in the WSJ article is particularly damning.

The sales pitch to urologists considering buying such a radiation facility predicts an income of $425,000/doctor from incorporating such a unit in his/her practice.

Medicynical Note: This behavior falls into a loop hole of the Stark provisions against self referral. Read the article for a more complete explanation. The doctor’s position that their treatment decisions are based solely on patient benefit would be more defensible if they did not participate in the entire revenue stream and if the radiation modality did not appear to be overused.

What’s depressing is that there seems no incentive to provide care at a more reasonable price (value).   Rather than take a cut in the  generous $425,000/year doctor profit  (this in addition to his/her other fees) these providers stick it  to our failing health care non-system.

With everyone at every level  concerned with  maximizing profit, is it any wonder that we spend 17% of GDP on health?  That our health care insurance system is failing? and that we can no longer afford it!

This is going on during a disastrous financial downturn.  But then again considering the behavior of our financial sector, maybe it’s a natural consequence of a medical establishment whose primary goal seems to be monetary rather than medical.