Navigation Links
Medicare reimbursement change meant to save money has opposite effect
Date:2/8/2010

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
david.sampson@cancer.org
American Cancer Society
Source:Eurekalert

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:
*Name:
*Comment:
*Email:
(Date:8/16/2017)... Bethpage, NY (PRWEB) , ... August 16, 2017 , ... ... Kullen, Long Island’s original family-owned supermarket, has put together suggestions for enjoying the season ... new recipe or activity, everyone in the family can join in on the fun. ...
(Date:8/16/2017)... ... ... August 3rd article on Reuters covers a new University of Michigan study on ... of the American Medical Association). The study found that a lower percentage of patients with ... to patients with lower BMIs. At present, weight loss patients must have a BMI of ...
(Date:8/16/2017)... ... August 16, 2017 , ... The Data Council, ... that it was acquired by Advantage Solutions. The Data Council’s IX-ONE platform ... include the industry’s leading suppliers, brokers, distributors and retailers. The Data Council will ...
(Date:8/16/2017)... ... August 16, 2017 , ... In 1987, ... celebrate 30 years in business this year, and they’re marking the milestone by ... to serve their patients. , It stands to reason that, given the ...
(Date:8/16/2017)... ... August 16, 2017 , ... Modern Consulting Insurance & ... program. Partnering once again with Boys & Girls Clubs of Greater Kansas City, ... area’s very own American Idol. With all proceeds benefitting local worthy causes, donations ...
Breaking Medicine News(10 mins):
(Date:8/15/2017)... Aug. 15, 2017   Mostyn Law and Gulf Coast ... Houston, Texas . The Mostyn Law family has ... years. That is why Mostyn Law is partnering with ... to show its appreciation. Blood supplies are running low. ... short of hospital needs in August. That is why the blood ...
(Date:8/14/2017)... Israel , Aug. 15, 2017 /PRNewswire/ ... of adult stem cell technologies for neurodegenerative diseases, announced ... 2017. "We are ... Phase 3 trial to investigate NurOwn ® in ... Executive Officer of BrainStorm. "We have agreements with Mass. ...
(Date:8/7/2017)... 7, 2017 Insightin Health, provider of ... and engagement, announced the selection of Michael ... Development, effective as of February 2017. In this role, ... strategy for our clients. Wood brings with him ... and business analytics within the healthcare industry. Wood ...
Breaking Medicine Technology: