Slanted Doctor-Use Studies Lead to Malicious Conclusions

Written by Scott Becker, JD, CPA, and Rob Kurtz | June 17, 2010

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The journal Health Affairs has published a study that indicates oncologists made up for reductions in payments by providing more chemotherapy and treatment using agents with higher margins. The authors essentially claim physicians increased the percentage of of lung cancer patients treated with chemotherapy from 16.5 percent patients to 18.9 percent.

The study was limited to lung cancer. The study, published by a liberal think tank and Health Affairs, infers that the cause and effect of the change is largely or solely monetary driven. Dr. Craig Earle, e.g., concludes "the financial incentive seemed to have an effect where there's not strong evidence or more than one good treatment option."

Here, the change in use was less than 2.5 percent. There are also many factors that can account for this change. For example, the study doesn't examine whether costs were offset through less use of radiation therapy or surgery.

The authors acknowledge that, "…we cannot infer the appropriateness of treatment or health outcomes from these data," indicating the study doesn't consider whether increased use of chemotherapy or changes in drug types demonstrated positive outcomes for patients.

The study doesn't consider whether research conducted on the effects of different types of agents possibly influenced physicians on agent choice.

Further, the authors state, "We did not observe chemotherapy acquisition costs and, thus, don't know the size of the margins physicians earned on the drugs." Such a statement would indicate the authors do not know if physicians actually increased their margins, which is a primary basis for the study's conclusion of financial motivation behind treatment decisions.

In short, the study appears to be another example of a study drawn up with the purpose in mind of both condemning physicians and the concept of fee-for-service medicine.

View the Health Affairs study.

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