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Non-Profits Use More Expensive Radiation Option

Posted 6/7/2013

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This is quite an alarming report from ASCO. The concerns about escalating health care costs identify many reasons for the expense. One that seems especially ugly is any suggestion that doctors or hospitals or other companies and institutions are driving up costs by providing more expensive treatments that are no more effective than less expensive alternatives. This article from MedPage, reporting on a study from Yale, states that Medicare recipients are 30% more likely to receive brachytherapy for radiation at for-profit hospitals than they are at non-profit institutions. Since Medicare reimburses at a higher rate for this choice, the implications seems pretty clear.

What is brachytherapy? Breast brachytherapy means placing radiation sources (usually tiny pellets the size of pencil lead) inside and adjacent to a cancer, or inside an area that may contain residual cancer after surgical removal of the visible tumor mass. It is worth noting that this technique has been around for 100 years and was the standard of care instead of the "boost" for breast radiation 30 years ago. At that time, and I remember this, women had daily external beam radiation for 4 to 5 weeks, and then were admitted to the hospital for a few days for brachytherapy.

I especially remember this as my mother, who had breast cancer in her 60s and then lived another 20 years to die of something unrelated, was admitted to our hospital for this part of her treatment on the very day that I was delivering my second daughter. I well recall a doctor coming into the labor suite and introducing herself as being from Anesthesia. Being a bit prickly at that moment, I quite assertively told her to go away, that I was doing fine without drugs, and she quickly told me: "Oh no, I am not here for you. I am about to care for your mother and wanted to give her a report before we put her under." (and then I felt badly for yelling at her as she was being so thoughtful. Wherever and whoever you are, please accept my apology) So, my mother and I were in the same hospital, two floor apart, for a couple of days. She stayed longer than I did, and I stood outside the window to her room to show her the baby; we could not enter the room due to the radiation.

But I digress. The positive explanation for selecting brachytherapy would be that it is much quicker, and it could be difficult for an elderly woman to come daily for 6 weeks for radiation treatment. That is not untrue. However, the very large discrepancy between the numbers at non-profit and for-profit hospitals is striking.

Here is the beginning of the article and then a link to read more:

ASCO: For-Profits Go for Pricier Breast RT Option

By Charles Bankhead, Staff Writer, MedPage Today
Published: June 05, 2013
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

CHICAGO -- Older breast cancer patients received costly brachytherapy significantly more often at for-profit hospitals, despite a lack of clear evidence of benefit, a large retrospective review suggested.

Medicare beneficiaries had almost 30% higher odds for receiving adjuvant brachytherapy at for-profit hospitals than at nonprofit ones, according to Sounok Sen, BSE, of Yale University, and colleagues.

The likelihood of radiation therapy overall and brachytherapy in particular was significantly increased among the oldest patients -- women 80 or older, Sen reported here at the American Society of Clinical Oncology.

Medicare beneficiaries receiving breast-conserving surgery at for-profit hospitals disproportionately received brachytherapy," he said. "The oldest women at for-profit hospitals received more radiation therapy overall, a difference largely driven by the use of brachytherapy."

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