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.