Payment Rates May Affect Breast Cancer
THURSDAY, April 28 (HealthDay News) -- Use of a costly breast
cancer therapy called intensity-modulated radiation therapy is
strongly influenced by what Medicare will pay for the treatment and
where radiation oncologists practice, according to a new study.
Researchers analyzed Medicare data for 26,163 women with
localized breast cancer who had surgery and radiation therapy
between 2001 and 2005. During that time, Medicare billing for the
treatment, called IMRT, increased more than 10-fold (from 0.9
percent to 11.2 percent of patients).
The average cost for radiation treatment within the first year
after breast cancer diagnosis was $7,179 without IMRT and $15,230
Billing for IMRT was five times higher in regions of the country
where the treatment was covered by local Medicare carriers than it
was in areas where it was not covered, the researchers said. They
also found that billing for IMRT was more common among patients
treated in freestanding radiation treatment centers (7.6 percent)
than among those treated in hospital-based outpatient clinics (5.4
The findings "suggest that with respect to breast radiation
therapy, much of the variation in cost can be directly attributed
to inconsistent treatment definitions and reimbursement rates
authorized by Medicare and its intermediaries," concluded Dr.
Benjamin D. Smith, of the M.D. Anderson Cancer Center in Houston,
and his colleagues.
The study is published in the April 29 online edition of in the
Journal of the National Cancer Institute.
The findings "confirm the suspicion of many, both within and
outside of the health care industry, that medical decision making
is too heavily influenced by reimbursement rather than medical
necessity," Dr. Lisa A. Kachnic, of Boston University School of
Medicine, and Dr. Simon N. Powell, of Memorial Sloan-Kettering
Cancer Center in New York, wrote in an accompanying editorial.
The American College of Radiology and the Radiological Society
of North America have more about
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