Doctor's Pay Linked to Choice & Cost of Cancer Drugs!

[RedOnce]

Study Links Cancer Doctors' Pay And Their Treatment

By Reed Abelson The New York Times

THURSDAY, MARCH 9, 2006

The way cancer doctors are paid may influence the choice of drugs they use in chemotherapy, a study published Tuesday concluded. The study, by researchers from the University of Michigan and Harvard University, was published in the current issue of the academic journal Health Affairs.

"Providers who were more generously reimbursed," the authors wrote, "prescribed more costly chemotherapy regimens to metastatic breast, colorectal and lung cancer patients." The researchers focused on the treatment of metastatic cancer, or cancer that has spread in the body, because they said doctors had the most discretion in treating patients in advanced stages of the disease and in prescribing chemotherapy treatments. Because there is little evidence that one chemotherapy drug works better than another, "the physicians have more control over the agents chosen," one of the authors, Joseph Newhouse, a professor of health policy and management at Harvard, said in an interview.

Unlike other physicians, a cancer doctor can profit from the sale of chemotherapy drugs in a practice known as the chemotherapy concession. These doctors are paid for the cost of the chemotherapy drugs given intravenously in their offices, even though they frequently purchase the drugs at lower prices than the amounts they are paid in insurance reimbursements. One government study said that cancer doctors, or oncologists, were receiving discounts as high as 86% on some chemotherapy drugs. The doctors then pocketed the difference.

While critics say this creates a potential conflict of interest among oncologists advising patients on treatment, the doctors have said the profit is needed to pay the high cost of running their practices. They also have said the revenue allows patients to be treated in their offices...

http://www.iht.com/articles/2006/03/08/business/sway.php

(edited for brevity)

[HysteryDiagnosis]

1. If you are going to do a course of chemo or two or 12, please read

up on what purified aloe extracts can do to mitigate the damage to bone marrow, white blood cell count, and general overall recovery from the bad side effects from this sort of treatment.

[Trillo]

2. Sounds like another accounting sham to the benefit of

a professional class, that has been legally allowed in the past. To what extent it is part of the wholesale/retail schism is unknown by me, but if the drug distribution industry works as an oligopoly, and prices for therapeutic agents out of patent are rising precipitously, rights to sell being sold off from the point of manufacture but the manufacturer keeps making it and agrees not to sell it to anyone else but the "rights holder": then, are the drug companies and doctors leveraging an artificially inflated wholesale/retail schism to keep the cost of treatment at doctor's offices higher than it otherwise needs to be?

Is 'the system' creating shell companies being run by favored persons and/or other affiliated 'corporate entities' simply to create a pyramidal accounting sham leading to industry specific hyperinflation as well as to undermine a free market and deliberately ration care for consumers?

So many bankruptcies are said to be for medical expenses, the doctors and health corporations that do this 'cost markup' as well as tacking on 'service fees' and accounting for them both as 'profit' must lack any economic empathy whatsoever. How can a doctor who claims to be "a professional corporation" be a human? Is that an alias and legal construct for "greedy SOB"?

Are doctors nickle and diming their patients? Do they truly need to? Or is it just to pay for that mansion so they can live on Highstreet USA and mostly to keep up with the rest of their professional 'pack'?

Was the historical American story of a doctor taking a live chicken in return for a house call simply a myth told to children and one designed to mitigate patients' perceptions of high fees and mask the tyranny of a professional class? Or did something fundamental change in the late 1800s, something in the laws governing the country, to make the consumer a preyed upon "class"?

[Celebration]

3. chicken thing not a myth

But then again physicians of old didn't have hundreds of thousands of dollars of college loans to pay off, and just learned their trade by being apprentices. Once professionals formed organizations that restricted competition in their fields (and they all do that), the result is what we have today--lots of schooling required, efforts to keep paraprofessionals from taking over minor tasks, etc.

I don't necessarily think it is the laws, but socially our country changed a lot when we came out of the Great Depression, people left the farm and small communities, went to more impersonal cities where whole neighborhoods grew up with only one socioeconomic class. So now the barber's child doesn't know the merchant's child or play with the physician's child. Life is much more impersonal, and television even keeps us isolated from others. Even individual schools and churches now do not have the broad group of people that they used to have.

So people that grow up isolated from others don't really "get" the connection among all of us. It is pretty sad. This mentality has always existed of course--it just hasn't been as pervasive as now.

[RedOnce]

4. "Chemotherapy concession" - info from a NYT article 1/28/03

The cancer specialists can make huge sums — often the majority of their practice revenue — from the difference between what they pay for the drugs and what they charge insurers and government programs.

Typically, doctors give patients prescriptions for drugs that are then filled at pharmacies. But cancer doctors, known as oncologists, buy the chemotherapy drugs themselves, often at prices discounted by drug manufacturers trying to sell more of their products, and then administer them intravenously to patients in their offices.

The practice also creates a potential conflict of interest for these doctors, who must help patients decide whether to undergo or continue chemotherapy if it is not proving to be effective, and which drugs to use.

Health insurers say they can buy these drugs much less expensively themselves and have the drugs shipped directly to doctors' offices. Some also want to keep better track of how the drugs are used.

Cancer specialists have successfully resisted most government efforts to take the drug concession away, arguing that they need the payments to offset high costs in the rest of their practices. An attempt by the Clinton administration to change reimbursement practices was strongly opposed by doctors, and by George W. Bush, who was then governor of Texas, among others. But support for change is growing, and some changes are beginning to take place.

http://www.chem-tox.com/cancerchildren/chemotherapy/index.htm

[Celebration]

5. And I wonder.....

Where might Dr. Frist stand on this issue? snicker snicker

[RedOnce]

6. Not sure...but, hold on a second while I make sure all the cats are here!