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Report: Doctors' $275M Study Questioned

Dr. Peter B. Bach, a senior adviser at the Centers for Medicare and Medicaid Services.The government already gives hospitals more money to submit certain quality measurements. For example, CMS measures how often hospitals give patients aspirin upon

Wed, 30 Aug 2006 23:41:00 GMT

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In 2005, CMS initiated a one-year demonstration project for cancer patients undergoing chemotherapy. The demonstration focused on measuring patient outcomes in three areas of concern often cited by patients undergoing infusional chemotherapy: controlling pain; minimizing nausea and vomiting; and reducing fatigue. Oncology Practices reporting data on all three factors qualified for an additional payment of $130 per encounter for chemotherapy administration (a financial incentive to use infusional drugs over oral drugs). That included a $26 patient copay.

A Republican, Senate Finance Committee Chairman Chuck Grassley, found out from the Health and Human Services' inspector general's office that the value of the approximately $300 million-a-year demonstration project to report this information was for nothing. Providers were being paid $130 to simply forward the data that was already collected.

CMS had decided to continue the demonstration project for 2006, with ad ditional reporting to take a further step toward encouraging quality care and promoting so-called evidence-based best practices that have been proven to lead to improved patient outcomes. According to CMS, the payment for this oncology demonstration project is $23 per encounter. The new 2006 demonstration project's objective is to have oncology payments increasingly focused on patient-centered care, rather than chemotherapy administration.

While a Michigan/Harvard study (before Medicare reforms) documented a clear association between reimbursement to oncologists for the chemotherapy and the regimens which oncologists select for their cancer patients, a "Pattens of Care" study (after Medicare reforms) showed results that Medicare reforms are still not working. It is still an impossible conflict of interest. Once a decision to give chemotherapy is taken, oncologists receiving more-generous Medicare reimbursements used more-costly treatment regimens. (Google: "Drug Selection in Breast Cancer Treatment")

According to findings in the American Medical Group Association's 2005 Medical Group Compensation & Financial Survey, most specialties saw modest increases in compensation in 2004. The majority of specialties experienced increases at or just above the rate of inflation, and the primary care specialties saw increases of 6% - 8.8%.

The survey found that during 2004 three specialties experienced the largest increases in compensation: general surgery (8.89%), pediatrics & adolescent (8.76%), and hematology & oncology ($8.52%). In addition to pediatrics and adolescent, other primary care specialties saw increases: family medicine (6.31%) and internal medicine (7.57%).