A new report published by the U.S. Government Accountability Office (GAO) has linked the growth in treatment for prostate cancer to physician self-referral.
The report found that the number of Medicare procedures for prostate cancer-related intensity-modulated radiation therapy (IMRT) performed by self-referring groups increased rapidly between 2006 and 2010 -- but declined among physician groups that didn't self-refer.
During the survey period, the number of prostate cancer-related IMRT services performed by self-referring groups increased from about 80,000 to 366,000, the GAO found, and costs associated with these services and the number of self-referring groups -- comprised of urologists and a small number of other specialties -- also grew.
Once providers began to self-refer, the percentage of their prostate cancer patients they recommended for IMRT rose: Those who began self-referring in 2008 or 2009 referred 54% of their patients who were diagnosed with prostate cancer in 2009 for IMRT, compared with 37% of their patients diagnosed in 2007, according to the GAO.
Among all providers who referred a patient diagnosed with prostate cancer in 2009, those who self-referred were 53% more likely to refer their patients for IMRT and were less likely to refer them for other treatments, such as a radical prostatectomy or brachytherapy, which are less costly but often equally appropriate, according to the report.
The GAO recommended that Congress consider directing the secretary of Health and Human Services, whose agency oversees the U.S. Centers for Medicare and Medicaid Services (CMS), to require providers to disclose their financial interests in IMRT to their patients, and that CMS monitor self-referral of IMRT services.
Urologists responded to the report, calling it misleading. The GAO provided no evidence that patients were being provided with IMRT inappropriately, said the American Association of Clinical Urologists, the American Urological Association, and the Large Urology Group Practice Association in a statement.
