- Physician treatment recommendations for cancer patients may be influenced by reimbursement incentives, according to a new study in JAMA Oncology.
- The authors analyzed 18 observational cohort studies on the association between reimbursement incentives and changes in reimbursement policy on cancer care delivery. Of those, 15 showed a link between financial incentives and physicians' choice of drug or treatment plan.
- Value-based reimbursement policies could help to align physician incentives with patient need and boost the value of care they receive, the study says.
This is the first systematic review of reimbursement policy and the impact on cancer care, according to the authors, and points to a role for value-based care in divorcing a doctor's treatment recommendations from incentives beyond what's best for the patient while considering appropriate costs.
Among the findings was that reimbursement incentives created self-referral practices at freestanding radiotherapy centers that led to greater use of radiotherapy. In two studies, freestanding centers were both more likely to prescribe radiotherapy and to choose intensity-modulated radiotherapy, or IMRT, which is reimbursed more generously than conventional radiotherapy.
The review also shows an association between profitability of systemic anticancer drugs and physicians' choice of medication. Doctors also were more likely to choose breast-conserving therapy plus adjuvant radiotherapy or mastectomy depending on which had the higher reimbursement.
"Although existing ethical standards prohibit physicians from allowing personal financial gain to influence treatment decisions, it appears such ethical standards alone may be insufficient to constrain physician behavior," the authors write. "The reimbursement incentives of cancer treatment may be particularly strong for physicians and practices facing financial hardship and attempting to remain solvent in the current landscape of health system consolidation and sequester-era reimbursement cuts."
To reduce these tendencies, policymakers should eliminate self-referral incentives and reassess charges for surgical fees, the authors say.
They also recommend separating reimbursement for anticancer agents from the price of the drug to discourage oncologists from opting for higher-priced agents along the lines of the Center for Medicare and Medicaid Innovation's Part B drug program pilot.