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Study: Financial incentive pushes doctors to prescribe chemo
Stethoscope and chart
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A new breast cancer study finds a link between the way private oncologists get paid and how much chemotherapy they prescribe.
by Gregory Warner
A new study finds that the financial incentive to push patients to chemotherapy can make doctors reluctant to offer a test that may tell breast cancer patients they don't need chemotherapy.
Private oncologists rely on the reimbursements they get from insurance companies for administering chemo. The money pays counseling, nutrition advice, and all the work that nurses do -- things that aren't covered so well by insurance. Julian Schink, a gynecological oncologist at Chicago's Northwestern Memorial Hospital who wrote the study, says it creates a financial dilemma for the oncologist. "It's hard to do the test that says, gee, don't give the patient chemotherapy, and it's money out of his pocket."
The test called a gene expression test can analyze the tumor tissue and predict the chance of that cancer recurring. If the risk is low, the woman may not need chemo. Christine Weldon, who directs the Center for Business Models in Health Care and co-authored the study, says insurance companies need to start paying doctors for all the work they do, not just chemotherapy. "Pay them for the time to have the discussion about the test, not having the drug reimbursement be driving the sustainability of their practice.
Some doctors Weldon interviewed for the study said they don't tell their patients about the test unless the patient brings it up first.
Gregory, I wanted to congratulate you on the selection of this post for July's Carnival of Trust, hosted this month by Doug Cornelius. The Carnival is held monthly and showcases the best posts dealing with the subject of trust in business, politics and society. Your post highlights a lot of fears and questions we have regarding the medical profession and how our own well-being can be affected by the professional outlook. We appreciate your insight and thoughts--hopefully this will keep the conversation going. The Carnival can be viewed in its entirety at: http://www.compliancebuilding.com/2010/07/12/carnival-of-trust/ Best, Kristin Abele www.trustedadvisor.com/trustmatters
I had the gene test, it said I only had a 7% chance of recurrance ever, so I did not do chemo. 14 months later I had the breast cancer again, more aggressive type, metastasized into the chest wall and sternum. And my insurance had refused to pay for the $3,500 gene test. I am Very Sorry I ever heard of the gene test...I will die sooner because I foolishly relied on it.
My breast cancer was detected early. My medical oncologist told me I had to have chemo - it's the standard. I was at my breast surgeon's for my (pre-chemo) port implantation surgery, and she asked me why I was having chemo. She called my onc & demanded I have the gene test. My recurrence score was low - proving I would not benefit from chemo. This article made my blood boil - all over again.
No where in the article did I see the word "greed." If you have ever had someone close to you go through chemotheraphy, you know how physically and emotionally debilitating it is. A frind of mine chose death over another round of chemotheraphy after he breast cancer returned. Why, other than greed, would a doctor put a patient through this ordeal when it may not be necessary?
