Are Small Reimbursement Changes Enough to Change Cancer Care? Reimbursement Variation in Prostate Cancer Treatment.


Journal Article

The Centers for Medicare and Medicaid Services recently initiated small reimbursement adjustments to improve the value of care delivered under fee-for-service. To estimate the degree to which reimbursement influences physician decision making, we examined utilization of gonadotropin-releasing hormone (GnRH) agonists among urologists as Part B drug reimbursement varied in a fee-for-service environment.We analyzed treatment patterns of urologists treating 15,128 men included in SEER-linked Medicare claims who were diagnosed with localized prostate cancer between January 1, 2000, and December 31, 2003. We calculated a reimbursement generosity index to measure differences in GnRH agonist reimbursement among regional Medicare carriers and over time. We used multilevel analysis to control for patient and provider characteristics.Among urologists treating early-stage and lower grade prostate cancer, variation in reimbursement was not associated with overuse of GnRH agonists from 2000 to 2003, a period of guideline stability (odds ratio, 1.00; 95% CI, 0.99 to 1.00).Small differences in androgen-deprivation therapy reimbursement generosity were not associated with differential use. Fee-for-service reimbursement changes currently being implemented to improve quality in fee-for-service Medicare may not affect patterns of cancer care.

Full Text

Duke Authors

Cited Authors

  • Ellis, SD; Chen, RC; Dusetzina, SB; Wheeler, SB; Jackson, GL; Nielsen, ME; Carpenter, WR; Weinberger, M

Published Date

  • April 2016

Published In

Volume / Issue

  • 12 / 4

Start / End Page

  • e423 - e436

PubMed ID

  • 26957641

Pubmed Central ID

  • 26957641

Electronic International Standard Serial Number (EISSN)

  • 1935-469X

International Standard Serial Number (ISSN)

  • 1554-7477

Digital Object Identifier (DOI)

  • 10.1200/JOP.2015.007344


  • eng