Navigation Links
Medicare reimbursement change meant to save money has opposite effect

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.


Contact: David Sampson
American Cancer Society

Related medicine news :

1. Former Los Angeles Medical Center Owners Agree to $10 Million Consent Judgment For Medicare and Medi-Cal Fraud Scheme
2. Thirteen Detroit-Area Individuals Arrested and Charged for $14.5 Million Medicare Fraud
3. MessageBroadcast Launches Automated Medicare Survey System for NebDoctors of Nevada
4. Clinic Manager Pleads Guilty in Medicare Fraud Scheme
5. Top-Rated Medicare Plan Now Offers Silver Life Fitness Program Free to its Members
6. CMS Launches Fifth Annual Medicare Health Care Provider Satisfaction Survey
7. InComm and Medagate to Launch Government Backed Medicare Products
8. Blue Cross Blue Shield of Michigan Adds University of Michigan Health System to New Medicare Advantage PPO Network
9. Cardiology Takes Legal Action Against Medicare
10. New Study Shows That American Public is Willing to Accept Major Reforms in Medicare Program
11. Masimo Rainbow SET(R) SpHb(TM) Measurement Receives New CPT Code and Medicare Pricing
Post Your Comments:
(Date:11/27/2015)... ... 2015 , ... The print component of “Supporting Our Caregivers” ... New York, Minneapolis, South Florida, with a circulation of approximately 250,000 copies and ... vast social media strategy and across a network of top news sites and ...
(Date:11/27/2015)... ... 2015 , ... A simply groundbreaking television series, "Voices in America", which is ... an array of issues that are presently affecting Americans. Dedicated to providing the world ... is changing the subjects consumers focus on, one episode at a time. , ...
(Date:11/27/2015)... Rosa, CA (PRWEB) , ... November 27, 2015 , ... ... Northern California Medical Associates, Inc. and Dr. Tucker Bierbaum with Emergency Medicine at ... meeting. They observed that both STEMI and Sepsis conditions present in similar ways and ...
(Date:11/26/2015)... ON (PRWEB) , ... November 26, 2015 , ... ... of a real-time eReferral system for diagnostic imaging in the Waterloo region. Using ... BMD and Nuclear Medicine tests directly from their electronic medical record (EMR) without ...
(Date:11/26/2015)... ... November 26, 2015 , ... ... process, participated in the 61st annual Employee Benefits Conference. The Employee Benefits Conference ... Sunday, November 8th through Wednesday, November 11th, 2015. The conference was held at ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... , November 26, 2015 ... A new combination approach blends immunotherapy with Bremachlorin-photodynamic therapy ... new combination approach blends immunotherapy with Bremachlorin-photodynamic therapy for ... new combination approach blends immunotherapy with Bremachlorin-photodynamic therapy for ... has found that immunotherapy can be efficiently ...
(Date:11/26/2015)... Research and Markets ( ) ... Future Horizons and Growth Strategies in the Japanese ... Segment Forecasts, Competitive Intelligence, Emerging Opportunities" report ... --> This new 247-page report ... drug monitoring market, including emerging tests, technologies, instrumentation, ...
(Date:11/26/2015)... , Nov. 26, 2015 Research and Markets ... "Advanced Wound Care Market by Type (Dressings, Therapy ... User (In-Patient Facility, Out-Patient Facility), and Geography - Global ... --> --> The ... definition and forecast of the global advanced wound care ...
Breaking Medicine Technology: