Medicare Compliance & Reimbursement

The startling conclusion of a study published online this Feb. 8 in Cancer -- a peer-reviewed journal of the American Cancer Society -- indicates that increased Medicare payments to physicians for outpatient surgeries for bladder cancer might have led to a steep rise in the number of procedures performed. This resulted in Medicare expenditure for outpatient bladder surgery procedures growing by almost twofold, a rise which could not be explained by the increase in the number of bladder cancer referrals during the corresponding period alone or the degree to which cancer was treated definitively in the office, noted the authors of the study.

The authors of the study compared Medicare reimbursements during 2002-2004 (Period 1) with reimbursements during 2005-2007 (Period 2) and found a 1.76-fold increase in Period 2 compared to Period 1.

"Our study was not intended to be an indictment of physicians or American medicine, but instead to explore how changes in Medicare reimbursement might influence practice patterns," said one of the study's authors, Samir S. Taneja, MD, director of the Division of Urologic Oncology in the Department of Urology at the New York University Langone Medical Center in New York City.

"Clearly, the intent of CMS in instituting these specific reimbursement changes was to shift bladder cancer care and bladder biopsies to the office from the hospital, as these are costly and frequent procedures," he told Medscape Oncology. "Overall, this should have resulted in a cost reduction," according to a recent post on www.sciencecentric.com. The post says there was an attempt to reduce costs in 2005 when Medicare increased physician reimbursement for office-based endoscopic bladder procedures, such as biopsies, but it didn't quite work out.

The reimbursement change was expected to result in reduced healthcare-related costs through the altered physician incentives via increased use of outpatient endoscopic surgery and a decline in hospital-based endoscopic surgery.To evaluate this hypothesis, Taneja and his colleagues assessed treatment patterns in their practice before and after the Medicare change in physician reimbursement.

The American Cancer Society study shows Medicare financial incentives for the outpatient treatment of bladder cancer may actually be increasing overall costs without improving care.

"Given the ongoing healthcare debate in Congress regarding reforming the current system, one wonders if many of the changes currently being proposed in Washington might not have similar effects to what we are seeing in this one isolated example," said David Penson,MD, MPH, of Vanderbilt University in Nashville, who was not involved with the study but wrote an accompanying editorial. 'Sometimes, policies have the exact opposite effect of what was intended,' he cautioned according to the post on Science Centric.

(Editor's note: To read the complete post on Science Centric, go to: www.sciencecentric.com/news/article.php?q=10020807-medicare-reimbursement-changemeant-save-money-has-opposite-effect.