Thursday, December 27, 2012

December 27, 2012 - Profit Centers

If you’re a cancer patient who has received chemo treatments in your doctor’s office, here’s an article that may give you pause.  It’s a Reuters article by Andrew M. Seaman, dated yesterday: “Some cancer docs say their income tied to treatments.”

As the article makes clear, it’s not a question of whether oncologists actually do make more money administering treatments in their offices (as opposed to referring patients to a hospital’s outpatient clinic). The question is whether the doctors THINK they do.

If they do think that’s the case, then there’s the potential for a disturbing conflict of interest.

Here’s the $50,000 (or more) question: “In the case of oncologists who also run chemo clinics, what takes first priority in their minds — the medical necessity of a given round of treatment or their potential to realize a higher profit?”

I’d like to think most doctors are above such venal considerations. Yet, I’m also enough of a Calvinist to believe no one is immune to that sort of temptation. Better to eliminate the temptation, I say, than to count on human nature to always pursue the most ethical course, when there are pecuniary considerations at work.

Speaking for myself, I have to say I still have great personal confidence in Dr. Lerner, my oncologist, even though he and his colleagues in the medical group do own a chemo clinic (where I did, in fact, receive my treatments). That’s because of a certain experience I've had. When, just after my R-CHOP chemo treatments had ended, the question came up about the advisability of maintenance Rituxan treatments in my case, Dr. Lerner recommended against it. He said, at the time, that in his view the body of research was still not there to declare that this was, indeed, the right thing to do.

I do realize it’s now over 6 years later, and the results of some more recent clinical trials would perhaps lead my doctor to give different advice today, but  the important thing, to me, is that he declined on medical grounds to recommend that expensive treatment that would have put more profits in his pocket.

It’s these very same maintenance Rituxan treatments, that can continue monthly for many years after initial chemo treatment, that some doctors refer to as their “Rituxan retirement plan.”

The historic pattern, with most medications, is for doctors to write a prescription and for a pharmacy to fill it. Unless the doctor also happens to own the pharmacy, there’s no conflict of interest. When doctors own outpatient chemo clinics, however, it’s as though the doctor owns the pharmacy.

The same is true for the “outpatient surgi-centers” that have sprung up all over the place — which are typically owned by the very same doctors who refer patients to them (and, in most cases, perform the surgeries as well). They’re essentially little freestanding, specialized operating-and-recovery rooms. They make it possible for patients to undergo outpatient surgery, complete with general anesthesia, without ever setting foot in a hospital. (An ambulance is permanently parked out back, to whisk patients to the hospital, should complications develop.)

The problem — for non-profit hospitals, anyway — is that the for-profit surgi-centers siphon off many of the operations that typically bring in more money than they cost to perform. This leads to underused hospital operating-rooms and a corresponding decline in hospital income. The hospitals, then, are stuck with paying all the costs of operations and outpatient treatments for uninsured or underinsured patients, who would never make it through the door of the doctor-owned facilities.

At the very least, I think you’ll agree: this is something worth pondering, right?

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