Reduction in Physician Reimbursement and Use of Hormone Therapy in Prostate Cancer
15 Dec 2010-Journal of the National Cancer Institute (Oxford University Press)-Vol. 102, Iss: 24, pp 1826-1834
TL;DR: The 2003 Medicare Modernization Act reduced reimbursements for AST by 64% between 2004 and 2005, but the effect of this large reduction on use of AST in prostate cancer is unknown.
Abstract: Background
Use of androgen suppression therapy (AST) in prostate cancer increased more than threefold from 1991 to 1999. The 2003 Medicare Modernization Act reduced reimbursements for AST by 64% between 2004 and 2005, but the effect of this large reduction on use of AST is unknown.
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TL;DR: SEER data should not generally be used for comparisons of treated and untreated individuals or to estimate the proportion of treated individuals in the population, andAugmenting SEER data with other data sources will provide the most accurate treatment information.
Abstract: Background:
The population-based Surveillance, Epidemiology, and End Results (SEER) registries collect information on first-course treatment, including surgery, chemotherapy, radiation therapy, and hormone therapy. However, the SEER program does not release data on chemotherapy or hormone therapy due to uncertainties regarding data completeness. Activities are ongoing to investigate the opportunity to supplement SEER treatment data with other data sources.
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TL;DR: A summary of Medicare data is provided, including the types of data that are captured, and how they may be used in epidemiologic and health outcomes research, to highlight strengths, limitations, and key considerations when designing a study using Medicare data.
Abstract: Medicare is the federal health insurance program for individuals in the US who are aged ≥65 years, select individuals with disabilities aged <65 years, and individuals with end-stage renal disease. The Centers for Medicare and Medicaid Services grants researchers access to Medicare administrative claims databases for epidemiologic and health outcomes research. The data cover beneficiaries' encounters with the health care system and receipt of therapeutic interventions, including medications, procedures, and services. Medicare data have been used to describe patterns of morbidity and mortality, describe burden of disease, compare effectiveness of pharmacologic therapies, examine cost of care, evaluate the effects of provider practices on the delivery of care and patient outcomes, and explore the health impacts of important Medicare policy changes. Considering that the vast majority of US citizens ≥65 years of age have Medicare insurance, analyses of Medicare data are now essential for understanding the provision of health care among older individuals in the US and are critical for providing real-world evidence to guide decision makers. This review is designed to provide researchers with a summary of Medicare data, including the types of data that are captured, and how they may be used in epidemiologic and health outcomes research. We highlight strengths, limitations, and key considerations when designing a study using Medicare data. Additionally, we illustrate the potential impact that Centers for Medicare and Medicaid Services policy changes may have on data collection, coding, and ultimately on findings derived from the data.
143 citations
Cites result from "Reduction in Physician Reimbursemen..."
...Elliott et al found that for the appropriate group of patients with metastatic disease, use of GnRH agonists did not change after MMA implementation but for males with very low-risk cancers, among whom there was a large decrease.(42) Additional studies were also able to evaluate cost implications, showing that payments to physicians for GnRH agonists decreased substantially between 2003 and 2005....
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TL;DR: The effects of pharmaceutical policies using financial incentives to influence prescribers' practices on drug use, healthcare utilisation, health outcomes and costs are determined and pay for performance policies are evaluated.
Abstract: Background Pharmaceuticals, while central to medical therapy, pose a significant burden to health care budgets. Therefore regulations to control prescribing costs and improve quality of care are implemented increasingly. These include the use of financial incentives for prescribers, namely increased financial accountability using budgets and performance based payments. Objectives To determine the effects on drug use, healthcare utilisation, health outcomes and costs ( expenditures) of policies, that intend to affect prescribers by means of financial incentives. Search strategy We searched the following databases and web sites: Effective Practice and Organisation of Care Group Register ( August 2003), Cochrane Central Register of Controlled Trials ( October 2003), MEDLINE ( October 2005), EMBASE ( October 2005), and other databases. Selection criteria Policies were defined as laws, rules, financial and administrative orders made by governments, non- government organisations or private insurers. One of the following outcomes had to be reported: drug use, healthcare utilisation, health outcomes, and costs. The study had to be a randomised or non- randomised controlled trial, interrupted time series analysis, repeated measures study or controlled before-after study evaluating financial incentives for prescribers introduced for a jurisdiction or healthcare system. Data collection and analysis Two review authors independently extracted data and assessed study limitations. Main results Thirteen evaluations of budgetary policies and none of performance based payments met our inclusion criteria. Ten studies evaluated general practice fundholding in the UK, one the Irish Indicative Drug Target Savings Scheme ( IDTSS) and two evaluated German drug budgets for physicians in private practice. The interrupted time series analyses had some limitations. All the controlled beforeafter studies ( all from the UK) had serious limitations. Drug expenditure ( per item and per patient) and prescribed drug volume decreased with budgets in all three countries. Evidence indicated increased use of generic drugs in the UK and Ireland, but was inconclusive on the use of new and expensive drugs. We found no clear evidence of increased health care utilisation and no studies reporting effects on health. Administration costs were not reported. No studies on the effects of performance- based payments or other policies met our inclusion criteria. Authors' conclusions Based on the evidence in this review from three Western European countries, drug budgets for physicians in private practice can limit drug expenditure by limiting the volume of prescribed drugs, increasing the use of generic drugs or both. Since the majority of studies included were found to have serious limitations, these results should be interpreted with care.
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TL;DR: In the course of recent health care fraud investigations against TAP Pharmaceuticals and AstraZeneca International, each pled guilty to one violation of the Prescription Drug Marketing Act, settled claims related to alleged violations of the False Claims Act without admitting guilt, and paid fines, settlements for liabilities, and reimbursements of dollar 850 million and dollar 355 million.
Abstract: In the course of recent health care fraud investigations against TAP Pharmaceuticals (Lake Forest, IL) and AstraZeneca International (London, United Kingdom), each pled guilty to one violation of the Prescription Drug Marketing Act, settled claims related to alleged violations of the False Claims Act without admitting guilt, and paid fines, settlements for liabilities, and reimbursements of $850 million and $355 million, respectively. In a unique aspect of these cases, federal investigators brought criminal charges against 14 TAP employees and investigated the billing practices of several urologists. These investigations resulted in guilty pleas from both urologists and industry employees relative to the Prescription Drug Marketing Act or the False Claims Act and probationary sentences with payments of fines and restitution to the government for urologists who cooperated with federal investigations. One uncooperative urologist was found guilty of violating the Federal False Claims Act and sentenced to 6 m...
11 citations
"Reduction in Physician Reimbursemen..." refers background in this paper
...The federal government reduced reimbursements for androgen suppression therapy (AST) by 64% between 2004 and 2005 as part of the 2003 Medicare Modernization Act, but whether this reduction resulted in decreased use of AST for prostate cancer is unknown....
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...The 2003 Medicare Modernization Act reduced reimbursements for AST by 64% between 2004 and 2005, but the effect of this large reduction on use of AST is unknown....
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...Faced with rising costs of AST, the federal government reduced AST reimbursement by 64% between 2004 and 2005 as part of the 2003 Medicare Modernization Act (17)....
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...Because payment for other chemotherapeutic agents was also reduced under the Medicare Modernization Act, this investigation is highly relevant to the current health-care reform debate as it pertains to cancer care....
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Journal Article•
TL;DR: The ultimate goal for urologists when making treatment decisions regarding LHRH agonist use is to continue to provide hassle-free, complete care for patients, including whatever medications they need.
Abstract: Reimbursement issues surrounding the treatment of prostate cancer with hormonal therapies have changed dramatically in the past 2 years. The ultimate goal for urologists when making treatment decisions regarding LHRH agonist use is to continue to provide hassle-free, complete care for patients, including whatever medications they need. This is still fully possible under the new rules without sacrificing the opportunity to profit from office-based administration of injectable medications.
9 citations
"Reduction in Physician Reimbursemen..." refers background in this paper
...Reimbursement for the drug itself was changed from paying 95% of the average wholesale price through 2003 to 80%–85% of the average wholesale price in 2004 to 106% of the average sales price in 2005 ($190 per 1-month depot in 2005) (32)....
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