Every Patient's Advocate

Games Oncologists Play – and WE Pay

Quite the exposé about oncologists and drug reimbursements is found in an article written by Alex Berenson in the New York Times.

The crux of the story is that oncologists — cancer doctors — have the ability to profit from the drugs they prescribe for their patients. When they prescribe chemo, or any of the drugs given to patients as a result of chemo (such as drugs to boost their strength or to help with their recovery from the ravages of chemo), they do so knowing they will make more money than if they simply met with the patient. Unfortunately, it seems that for many of these oncologists, their goal is focused on milking the system for all it’s worth — not simply to profit — er, um, excuse me — to treat their patients.

To quote Dr. Robert Geller from the article, “As long as oncologists continue to be paid by the procedure instead of for spending time with patients, they will find ways to game the system, however much money they make or lose on prescribing drugs…”

Game the system???

OK — so here’s what I think: I have no problem with profit-making. I have mentioned that before. I’ve been in business, and been a business owner, for many years and there’s no sense of being in business unless the intention is to make money. That’s what makes our capitalistic world go ’round. However….

What I do have a problem with is HOW these drugs are being used. For these reasons:

1. Oncology is the only medical specialty where the doctors are allowed to profit from the drugs they prescribe. And profit they do! Not only do they get reimbursed by medicare or private insurance, but they get kickbacks (excuse me — rebates) from the drug companies, too. Even when medicare cut off their open supply of reimbursement money two years ago, they continued “gaming” the system.

2. Because of the Medicare rule changes made to oncologist reimbursements two years ago, and according to the NYT article, oncologists simply began prescribing the more expensive drugs (so the percentage of reimbursement would yield a higher return) or drugs the patients may not have needed. For example, not all cancer patients need an anemia-related iron boosting drug — but it is prescribed more often now because the doctor can get reimbursed.

3. Patients are being treated with drugs/chemo when treatment may not be their best choice. Ohhh man! Can I speak to that one!! One example is my mother-in-law’s treatment for ovarian cancer, which I’ve actually blogged about several times. The oncologist insisted she have surgery, then chemo — at the age of 86!!

And then there is my own situation — when I was told by my oncologist that I needed to begin chemo immediately or I would be dead within months. Never mind the fact that I didn’t really have cancer!! I did accuse him of insisting I undergo chemo because it was the only way he could make money off of me. At the time (Fall of 2004) I didn’t know anything about reimbursements or oncology drug profits — it was purely a guess on my part. Pretty good guess, it turns out.

Here’s a way to look at this if you want to understand it better: Your kids are running a lemonade stand where they are selling lemonade and grape juice. A thirsty person comes along and asks which one will quench his thirst better. The kids know that for each cup of lemonade they sell, they make 25 cents in profit, and for every cup of grape juice they sell, they make only 12 cents profit. Of course, they can’t be sure which of those will really quench the person’s thirst — so which one do you think they will recommend?

yeah. it’s that simple.

Are patients healing better? Is their health improved because of oncology drug games? No. The right drug in the right dose at the right time is the only way to be sure a patient will recover better. Under no circumstances can anyone claim that giving more of a drug, more often, or infusing a more expensive drug is indicated just because a doctor makes more money from it, will help anyone heal better.

Are patients suffering because of this profiteering? The NYT article points to patients who are being treated despite the fact that they are reaching the ends of their lives, and the quality of their lives would be better if they weren’t suffering through chemo. That’s almost criminal. I certainly would have suffered if I had ever gone through chemo, as my oncologist recommended, because I didn’t really have cancer. The chemo itself could have killed me. Admittedly mine was a very unusual case, but it also proved it’s not unheard of.

What may be suffering the most is the “system”, and our collective pocketbooks. Because of these expensive reimbursements, because we are taxpayers and underwrite medicare, WE are the ones putting the money in the pockets of those oncologists — the ones who have been allowed to play in a different ballpark than their colleagues by profiting from drugs.

There is something VERY wrong about that. And what is even more frustrating is that this “game” makes it seem like this dike just can’t be plugged.

Sharp patients will learn what they can about the drugs — chemo and infusion — that are prescribed, and to continually question whether they are necessary and in what doses. Ask questions, double check when you can.

Realize, too, that a whole ‘nother aspect of our American health system debacle is that we don’t really have any way to make sure it’s being done right. But then, that’s another blog for another day.

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