COMMENTARY

Do Physician Payments Bias Their Treatment Recommendations?

Gerald Chodak, MD

Disclosures

November 19, 2010

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Hello. I'm Dr. Gerald Chodak from Medscape. At a recent meeting, I learned that the compensation to physicians who own the equipment and do intensity-modulated radiation therapy (IMRT) for localized prostate cancer is somewhere between $30,000 and $35,000 net profit. For physicians who do radical prostatectomies, the net profit is between $2,000 and $3,000, depending on who is paying for it. Active surveillance doesn't pay nearly as well. You are paid for an office visit and maybe periodically, you earn money from doing repeat biopsies. But a question to ask is whether these differences and disparities in compensation in any way influence the kind of treatment that men receive. They're far more likely to end up with radiation or surgery than with active surveillance, even if they are a good candidate for the latter.

Granted, many men have trouble deciding to choose active surveillance for a variety of reasons. But I wonder what would happen if all of a sudden the diagnosis of prostate cancer resulted in a constant fee no matter how the patient was treated? That means whether the patient had surgery, radiation, active surveillance, or anything else, the compensation would be the same. What would be the net benefit or result? Would patients be better served by telling many of them that they really don't need to be treated any more because their cancer may pose little threat to their lives? What about for the healthcare system? It certainly costs a lot more to do radiation therapy than it does to do active surveillance. So, maybe such an approach would result in 2 things: saving money for the system and also keeping men from getting a treatment they are not likely to benefit from.

With our healthcare system today, I believe we have a real potential conflict of interest. It may be below the surface, but the bottom line is that we are paid far more for doing certain things than others, and to some extent, that can create bias. Most patients would like to believe that their physician would never think about those issues, but as you look for different advertisements around the United States, clearly technology and aggressive therapies with different forms of radiation are being heavily promoted. I've yet to see a sign saying, "Active surveillance may be the right treatment for you." So, I welcome your comments with the idea that maybe we ought to standardize compensation for the management of this disease and take out of the equation the potential bias that can result in differences in the way physicians are compensated. Thank you.

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