Practice Type May Incentivize Administration of Chemotherapy, Growth Factors

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(ChemotherapyAdvisor) – Oncologists in a fee-for-service practice or paid a salary with productivity incentives were more likely to report their income would increase when they administer chemotherapy or growth factors than their salaried colleagues, a study reported in the Journal of Clinical Oncology online December 26.

“The annual cost of cancer care in the United States exceeded $124 billion in 2010 and is projected to be $173 billion in 2020,” reported Jennifer L. Malin, MD, PhD, of the Jonsson Comprehensive Cancer Center and David Geffen School of Medicine at University of California at Los Angeles and Greater Los Angeles VA Healthcare System, Los Angeles, CA, and colleagues.

The increased cost of treating cancer is related to “new diagnostic and treatment technologies and pharmaceutical and biological treatment innovations,” she noted, with concerns “raised about financial incentives associated with the chemotherapy concession in oncology practices and their impact on treatment recommendations.”

To measure effects on United States (US) medical oncologists' income of prescribing chemotherapy or growth factors or referrals to other cancer specialists, hospice, or hospital admissions, the investigators surveyed those caring for a population-based cohort with lung or colorectal cancer from the Cancer Care Outcomes Research and Surveillance (CanCORS) study. The medical oncologists were asked about their perceptions of the impact of prescribing practices or referrals on their income.

Of the final study sample of 480 participants, 52% were ≥50 years of age, 23% were female, 78% were graduates of US or Canadian medical schools, 92% were board certified, and 51% were engaged in teaching.

Most medical oncologists reported their income to be unaffected by their prescribing of chemotherapy or growth factors, or by referrals. “However, 27% indicated that their income would be increased by administering more chemotherapy, 25% by prescribing more growth factors, and 11% by admitting more patients to the hospital,” the authors wrote.

Physicians in fee-for-service practice and those paid a salary with productivity incentives were more likely to report their income “would increase from administering chemotherapy (odds ratios [ORs], 7.05 [95% CI, 3.22 to 15.43] and 7.52 [95% CI, 3.29 to 17.23], respectively; both P<0.001) or administering growth factors (ORs, 5.60 [95%CI, 2.47 to 12.71] and 6.03 [95% CI, 2.48 to 13.79], respectively; both P<0.001),” they reported.

An accompanying editorial noted, “Uncoupling the relationship between prescribing patterns and income may be an important step in controlling cancer costs. Important changes are needed and should be made thoughtfully, with rigorous assessment of outcomes and reasonable time frames for adoption. The oncology community needs to work with public and private payors to determine how practices can be appropriately compensated for providing high quality care that extends life meaningfully and reflects patient and family preferences.”

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