Following the Medicare reimbursement plan of 2005, which increased payments to physicians for outpatient surgeries for bladder cancer, a dramatically higher number of bladder cancer cases were treated in the outpatient or physician office setting, but the number of hospital-based bladder cancer procedures did not significantly decline, according to a report published Feb. 8 in Cancer.
“Procedures performed in the office offer potential cost savings. Recent analyses suggest, however, that a fee-for-service system may incentivize subscale operations and, thus, contribute to excessive spending,” wrote lead authors Micah Hemani, MD, and Samir Taneja, MD, from the division of urologic oncology at the New York University Langone Medical Center in New York City, and colleagues.
The researchers--seeking to characterize changes in the practice of office-based and hospital-based endoscopic bladder surgery since 2005--identified all office and hospital-based endoscopic surgeries that were performed in a faculty practice from 2002 to 2007 using billing codes for procedures, diagnoses and procedure locations.
The authors found that of the 1,341 endoscopic bladder surgeries that were performed since the new reimbursement plan, 764 took place in the office setting and 577 were in the hospital. In addition, the odds ratio for surgery occurring in the office was 2.01, compared to the hospital at 2.29.
According to the researchers, the most noteworthy finding was the overall estimated expenditure rate of Medicare payments, which increased by 50 percent. Moreover, the number of outpatient procedures increased, while the likelihood that a procedure would lead to a bladder cancer diagnosis declined.
"We believe these trends are disturbing as they may reflect both diagnostic and therapeutic over-utilization of office-based endoscopic bladder surgery," wrote Hemani and Taneja.
While the reasons for the increase in the use of outpatient procedures in regard to bladder cancer and the detection of the disease remains unknown, the authors noted that the research findings highlight a need for more stringent clinical guidelines and policy measures, as well as greater accountability for the physicians who utilize these office-based surgeries that increase overall costs without improving patient care.