Allowing urologists to self-refer patients for intensity-modulated radiation therapy (IMRT) treatments contributes to overuse of this expensive therapy, according to new research published in the New England Journal of Medicine.
Study author Jean Mitchell, PhD, an economist from Georgetown University, found that urologists who acquired ownership of IMRT systems increased their use of the therapy substantially more than urologists who did not own such services. Urologists may own IMRT devices under the Stark law's in-office ancillary services exception, Mitchell wrote (NEJM, October 24, 2013, Vol. 369:17, pp. 1629-1637).
For the study, Mitchell used Medicare claims data from 2005 to 2010 covering more than 45,000 patients. She compared 46 urology groups that self-referred with a control group of 46 urology groups that did not self-refer, examining the use of IMRT in the periods before and during ownership.
The rate of IMRT use by self-referring urologists increased 19.2 percentage points, from 13.1% to 32.3%, Mitchell wrote. Among urologists who did not self-refer, the rate of IMRT use increased 1.3 percentage points during the time period, from 14.3% to 15.6%.
Representatives from the American Society for Radiation Oncology (ASTRO), which represents radiation oncologists, were quick to seize on the findings.
"Dr. Mitchell's study provides clear, indisputable evidence that many men are receiving unnecessary radiation therapy for their prostate cancer due to self-referral," said ASTRO Chairman Dr. Colleen Lawton in a statement. "We must end physician self-referral for radiation therapy and protect patients from this type of abuse."
But the findings have drawn a swift response from urology groups. A statement released by the Large Urology Group Practice Association (LUGPA), which represents more than 2,000 urologists across the country, attacked the study, pointing out that it was commissioned and funded by ASTRO, whose members compete with urologists for prostate cancer patients.
"Dr. Mitchell's work appears to be specifically designed to produce talking points for the sponsor's political agenda," the LUGPA statement said.
Mitchell did not match her control group for practice size, patient demographics, or severity of disease -- which contributed to the "bizarre results," according to Dr. Deepak Kapoor, LUGPA's president.
"Her own data confirms that urologists with ownership of radiation oncology use the technology appropriately and responsibly," Kapoor said.
