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The Making of Medicine

Is Money Compromising Cancer Care?

A troubling new study from our Timothy Showalter, MD, points out that providing brachytherapy for advanced cervical cancer actually costs hospital money. And that may explain the declining use of it at many facilities, even though it’s the gold-standard treatment.

“Studies have time and time again shown that brachytherapy is the most important part of cervical cancer treatment, because it is essential to eradicating the tumor,” said Dr. Showalter, a radiation oncologist at UVA Cancer Center. “A decline in brachytherapy utilization is associated with a higher rate of mortality in cervical cancer, so there’s a direct relationship.”

Dr. Showalter found that Medicare actually reimburses four times more per minute required for a less effective alternative, external beam radiation, than it does for brachytherapy. This even though brachytherapy costs hospitals more and requires more physician resources. “I can certainly imagine how the comparatively poor reimbursement rates compared to external beam radiation could contribute in some environments to not establishing a service for brachytherapy or just not committing physician time to it,” Dr. Showalter said.

He and his fellow researchers concluded that hospitals that see a high volume of patients, such as UVA, are best equipped to provide brachytherapy – because they can more easily absorb the costs and necessary resource commitment. “We’re at this big hospital with all the equipment we need at the ready and a wonderful streamlined process that enhances the patient experience and reduces patients’ time on the table,” he said. “That makes it easier to provide efficient and effective care.”

But what about the smaller healthcare facilities that aren’t so lucky, that don’t have large staffs and don’t have all the equipment standing by, ready to go? As Dr. Showalter notes: “If practices don’t run at least a profit greater than zero, then they fold.”

Worrisome, huh? Dr. Showalter agrees. “It’s disturbing because we have this great treatment option that’s an absolute requirement of curative therapy, and it’s been available for decades, but the rates of actually using it are dropping,” he said. “It’s like if you had an effective drug and people stopped using it.”

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