Using claims data from the U.S. government's Medicare insurance program for the elderly, Mitchell found that urologists who didn't own the equipment prescribed IMRT for 15.6 percent of their patients in 2010, compared with 14.3 percent five years earlier. Its use among the NCCN doctors stayed constant at about 8 percent, while it soared to 44 percent among a matched-group of doctors who started to refer patients to their own radiation treatment facilities.
"It's crazy the way the system is set up," Mitchell said in a telephone interview. "The patients are going to do what their physician tells them to do. The patient becomes almost like an ATM machine, with the doctor extracting as much revenue as they can."
The leader of a national urologists' group said the doctors who own radiation oncology equipment use the technology appropriately.
Mitchell's study "shows that less than one-third of newly diagnosed prostate cancer patients who sought treatment from an integrated urology group received IMRT," Deepak Kapoor, president of the Large Urology Group Practice Association, said in a statement. "This figure is fully in line with data from academic literature that predates the development of integrated groups."
Physicians in general aren't allowed to refer their patients for treatment in facilities that they also own, because of the financial conflict of interest. However, radiation, as well as in-office ancillary services, such as doing blood work and x-rays, are exempted under U.S. law. The exception was created for patient convenience. It's unclear why radiation, which is a treatment and not an ancillary service, was exempted, Mitchell said.
The situation may actually harm some patients. The analysis found that doctors who owned the IMRT therapy were treating men ages 80 and older just as aggressively as younger men with early stage prostate cancer. Since the cancer is generally slow- growing, and radiation can carry immediate side effects, including erection problems and urinary symptoms, the older patients may experience only the harms and no benefits.