Doctors and Money: The Rising Cost of Cancer Care
It is no surprise that doctors earn a living caring for patients, and that cancer specialists are paid to care for cancer patients. But many may not be familiar with how doctors in the US are paid, nor how closely linked are specific treatment recommendations and doctor's earnings. In the next several blogs, I wanted to touch on aspects of doctors and money.
The issue of oncologist earnings has been put forward recently as part of a larger emerging dialogue that centers on the growing cost of cancer care. Because of progress in helping treat cancer and alleviate symptoms in cancer patients, the cost of cancer care is continuing to rise steadily. Much of this may represent genuine progress - the availability of new, effective anti-cancer drugs, and the utilization of better supportive care have been dreams for patients and doctors for decades. But such progress comes at a cost. An aging population, longer survival with cancer, higher prices for new drugs, and rising expectations for fewer side effects all have contributed to increasingly expensive oncology practices.
In medical oncology, physicians (or their group practices, hospitals, or affiliated cancer centers) are paid both for consulting services - that is rendering opinions and guidance - and for delivering care with chemotherapy or other interventions. This creates the potential that treatment choices are driven by consideration of financial remuneration. This is not fundamentally different from other medical specialties (for instance, surgeons get paid to operate), or for other professions (lawyers are paid for services they render). But the implications in oncology, where there are more and more treatment choices emerging, are only beginning to be studies.
A recent article in the New York Times highlights some of the areas of controversy for doctors and patients, and money.
I would be interested in your experiences. Do you think that your treatment, or aspects of it such as drug choices or schedules, have been influenced by the kind of reimbursement the medical team got? If so, add your voice to the discussion.
Related Topics: Technorati Tags: oncologist, cancer treatment, payment, money, health and wellness
The issue of oncologist earnings has been put forward recently as part of a larger emerging dialogue that centers on the growing cost of cancer care. Because of progress in helping treat cancer and alleviate symptoms in cancer patients, the cost of cancer care is continuing to rise steadily. Much of this may represent genuine progress - the availability of new, effective anti-cancer drugs, and the utilization of better supportive care have been dreams for patients and doctors for decades. But such progress comes at a cost. An aging population, longer survival with cancer, higher prices for new drugs, and rising expectations for fewer side effects all have contributed to increasingly expensive oncology practices.
In medical oncology, physicians (or their group practices, hospitals, or affiliated cancer centers) are paid both for consulting services - that is rendering opinions and guidance - and for delivering care with chemotherapy or other interventions. This creates the potential that treatment choices are driven by consideration of financial remuneration. This is not fundamentally different from other medical specialties (for instance, surgeons get paid to operate), or for other professions (lawyers are paid for services they render). But the implications in oncology, where there are more and more treatment choices emerging, are only beginning to be studies.
A recent article in the New York Times highlights some of the areas of controversy for doctors and patients, and money.
I would be interested in your experiences. Do you think that your treatment, or aspects of it such as drug choices or schedules, have been influenced by the kind of reimbursement the medical team got? If so, add your voice to the discussion.
Related Topics: Technorati Tags: oncologist, cancer treatment, payment, money, health and wellness
23 Comments:
YES treament is based on money alone. My Father is dying because his "Dr" saved the insurance company money by NOT giving a man in his late 60's a colonostopy as part of his physical. Then when the 5 different chemo's didn't work the VA sent him home to die.
Are u serious...Are Drs earnings related to drug recommendations..have u heard of vioxx?
I disagree that treatment is based on money alone. I was diagnosed 3 years & 9 months ago with stage 3c ovarian cancer.At the time I had very poor insurance coverage. I received very aggressive IV chemo for 9 months to the tune of over $80,000 a month for just the medicines. No cost to me. I then received 1 year & 3 months of oral chemo to the tune of over $6,000 a month. I saw my gyne/oncologist every month for the first year and every 3 months since then. I get CT scans every 6 months. I have had a Pet Scan after my IV chemo was finished. If the insurance company wished to save money they could have denied the oral chemo as not medically necessary because it was for maintenance only. They could have denied the Pet Scan because CT Scans are recommended & then if anything is found they could then approve a Pet Scan. I have blood work done every 3 months at no expense to me. I have been in remission from the start. It is better to pay for treatment geared to a remission instead of not paying & then needing to start all over again when there is a recurrence.
I too am finding that due to the aging population, that the current theme of treatment for those 55 and older is to not diagnose cancer and to medicate symptoms with cheap pain killers and lectures about diet and exercise. The rule of thumb is that if you spot it, you have to treat it. If you don't screen for it, then it doesnt exist. It may be more humane to go this direction and save the cancer cure miracles for the younger set who will have to find out for themselves at an older age whether or not the miracle cures were just delay of the inevitable or have created a new source of income for medical treatment in the future, such as treating the treatments for cancer.
I believe with all my heart that there are a FEW Docs that want to Help people. But just a few....There is way, way too much money involved for this to honestly be a profession for 'healing'. I also believe that when we turn 55 most cancer screenings are put off since we are no longer considered an asset to society.
I TRULY believe too, that there ARE CURES for cancer but you will only find them in other countries as the amount of money generated by a cancer diagnosis is too great for our AMA and Gov't to give up. This is sad, but I believe if everyone just died of cancer very quickly, like AIDS, there would have been many more cures for many more cancers available to us. (The AMA cannot collect monies from us when we are dead.) Instead, the human has a natural instinct to stay alive, therefore we put up with the Docs mutilating our bodies, taking breasts off of women, putting us through tortuous tests that would be illegal in a POW camp, all in the name of medicine. We all need to be curious about the horror stories of our gov't trying to keep us from finding out about the cures that are available in Germany, Russia & France. I have not verified this but I am seeking answers as if this were true, it would be the ultimate devious betrayal of trust that a gov't could do to it's citizenry. If this sounds angry, it is. Because my Mother has had both breasts removed, undergoes tortuous biopsies and tests and still has 'faith' that her Docs are not in it for the money, but they truly want to help her.
BTW..at age 68 she still works full time, just comleted 3 years at a junior college for computer medical billing with a 3.9 avg and IS STILL an asset to society. My Father also works full time and he is 73. He too is STILL an asset to society!
No matter, if we had only physicians who wanted to heal people, not their pockets, age would not be an issue. Healing would be of utmost priority.
I see a well known oncologist in Virginia who specializes in prostate cancer. He prescribes but does not administer drug therapies. I go to a local infusion center or urologist when I need a treatment. My oncologist once told me that he is very much aware of the ethical aspects of both prescribing and administering drugs to his patients. He is the only oncologist that I know that follows this practice.
Is it obscene when a homeopath, medical oncologist, internal medicine certified doctor all wraped up into one takes an 8 oz bottle of a homeopathic solution which costs him $150, dilutes it into 6 doses for an IV, and then charges $300 for for each dose? That's $1800 gross for a $150 investment minus the cost of a IV bag, solution, and a girl sticking a needle in your arm. Let's see now. That's $36,000 for a $3,000 investment minus 20 each IV bags with solution, and a girl sticking needles in an arm in a 8 hour day in a infusion room. Oh, you say there might be 40 people in the infustion room for the 1 1/2 hour treatment? Then keep doubling those figures to suit the infusion room you sit in. Don't forget the building, insurance, utilities, the wife's/husband's credit card bills. Oh, you say the poor doc only makes $10,000 a day after all those expenses. That's $2,600,000 a year to send his four kids to Harvard, new cars, 6 bedroom house, blah, blah, blah. Sound about right for your cancer doc? "First, do no harm." Ever hear of that one?" The docs make $30 a month in China where they actually cure a lot of cancers. Bye for now, I have to go take one of my pills that cost $15 a day. I take about 36 different pills a day.
My mother, father, and older sister all had cancer and followed the traditional medical treatments. They all died as a result. Three years ago, I was diagnosed with a agressive prostate cancer and warned by my urologist that I had to have immediate radiation, surgery, or chemo. Instead, I exclusively used alternative treatments and am now free of cancer -- without the byproducts of becoming impotent and incontinent as may be expected with conventional "cures."
Use your own judgement about costs. Can you really believe that MDs are so stupid as to really dismiss natural methods of curing, if it were not for the money involved in traditional treatments?
I am a recent breast cancer survivor. I saw the NYT article about chemo and it made me so angry. I believe that chemo is pushed on women with early stage breast cancer because it makes oncologists feel safer and women aren't being given information about how other things, most especially, regular exercise, can improve their survival chances. (And wouldn't you know it? At the same time the NYT article was published, a study was presented at the ASCO meeting showing that chemo doesn't work for over 90% of the women who receive it as an adjuvant therapy for breast cancer). I'm not sure many oncologists even know about the results published in JAMA in 2005 or JCO in 2006 (for colon cancer) about physical activity and cancer survival. And if they do, they are not telling their patients. I have spoken with many women with breast cancer and not a single one of them was told about exercise. Of course, no one can patent exercise so drug companies aren't interested in promoting the message and exercise is not a procedure that can get reimbursed by Medicare or other health plans. That's why it is up to patients and their loves ones to be their own health advocates. And there are a few non-profits that are trying to get the word out. Exercise is not an alternative therapy. It benefits are well-documented in the leading, peer-reviewed, medical journals. Rather, it should be viewed as an essential therapy and get reimbursed just like chemo and surgery.
My problem...it appears that the younger generation has found away of ridding itself of the older generation by refusing to offer medical/cancer treatment to older people, so that they may reserve it for the young! If it wasn't for us old people, you young would not even exist, nor would your treatment!
My husband has been treated for liver cancer for 2 years now. If you think it is not about money you need to see a shrink ( at a special cost to you).The treatments for chemoembolization to the liver are an average of $18,000.00 a pop, then there's the radiologist, the hospital, the oncologist, lab, x-ray tech. etc, etc.The medication they recently started him on costs $10,500.00 for 200 pills. Do the math. The natural alternative way is way cheaper, but you have to find a doctor who will work with you on that type of treatment. Not availible. Most doctors go to college to learn a profession on one area and that's to make money.They say they work as a team on your condition for cancer.. think again. When records are sent to the wrong doctors, or not sent at all to the so called cancer team, no one reads your file.( nurses, doctors, care givers)The medical profession is whining about not getting enough money for staff, nurses, while they are remodeling their new hospital wing or new cafateria. Right it is about money. You have to take charge of your own treatment because one hand doesn't know what the other is doing.
I had a second melanoma (4 years apart)(enlarged cancerous lymph node) surgically removed, sentinel nodes removed, PET proved negative, and was believed to be cancer free. Because of the two events and location of the second, I was recommended for Interferon therapy. To date, just the drug has cost nearly $18,000 through 8 months. (one month earlier of intense drug therapy administered by the oncologist daily at higher doses is an unknown cost) I have catastrophic drug coverage, but pay $175 a month representing 5% of cost for this level 4 drug even after going through the "donut hole". I believe that the year long therapy is due to the drug company study confirming this protocol. It could probably be 6 months and just as effective. The doctors are excellent but caught in the web of AMA approved techniques.
PS: the therapy is very difficult and causes lack of energy and instability, restricts level of exercise, and general malaise. Blood counts are down to half of prior level. I have lost about 25 lbs from 182 to 157.
DXed 4/2/07 started chemo 4/20/07
I am A fighting I B C WARRIOR (inflammatory breast cancer) RARE AND DEADLY. For info go to www.mdanderson.org and search for I B C. Its not the drugs that dont work, I think its the Doctor that doesnt work. They dont prescribe the correct drugs for each case. In my case GOD BLESS DR. N SHAH. I have a 80/20 insurance plan first question I am ask anywhere I go even if its for the sniffles is WHAT KIND OF INSURANCE DO YOU HAVE IF ANY?
Treatement is money dependent in many cases. MDAnderson cancer center refused to continue treatement when I fell about $5000 behind and was sent to collection. They also retroactively unaacepted my medicaid referral (thank god I also had student insurance), wouldn't give me hotel vochers even when I was taken to social services by their security force for sleeping on couches in their lounges and in my car...I still haven't finished my breast reconstruction 4 years later due to finances.
When you have to rely on public programs like the Burton-Hill (?Hill-Burton) program that money runs out after about June, medicaid takes forever to approve things (2 months for approval to be treated at MDAnderson Cancer center), many things are denied and no one cares (for example the one depression medication that was working at the time I also had cancer so I went through the process of the drug company free program but that takes time) because after all a measure of our worth in USA society is the size of our pocketbooks.
there is no doubt in my mind that there was less interest in me as a patient as soon as my treatment was over. i changed onocologists in the middle of treatment and my new "gang" could not have been nicer. now that i am finished i can not get a call back let alone a current appointment. i do not produce $8000+ a crack anymore so why bother. i think they would be happier with recurrance. i will never go back to them. i will spread the wealth. hate the cancer and hate the industry it has created. Getting chemo is like being on the assembly line. and boy do they hate you if you do not have a pick line or port. they have to spend way too much time with you. ask any health corporation how many proceedures they exected per day 10 years ago and what the quota is today. any technician that does not meet quota soon gets fired and if they meet quota they will get only an "average" rating. the excellent ratings only go to those who exceed the quota. it does not matter if they take the test properly or make a correct diagnosis just how many they can do it a day. the patient has nothing, nada zero to do with what the health corp makes, only that their insurance make the payment. also, make sure you have insurance or you will be bankrupt. the hospital charges $8000.00, the insurance company bargains that down to 2000.00, you pay your 25% and all is well with "Big Health". if you have no insurance the hospital bills you the full and smiles all the way to starbuck's and gossip about patients.!
I was primary caregiver for my ex-husband during his fight with lung cancer. He was lucky to have medicare and good insurance to pay his costs. I agree that we are in a health insurance and health costs crisis but I must say that none of the doctors he was treated by here in Atlanta attempted to milk the system by trying to sell him on treatments that he did not want and that all of them clearly informed him of his options. The doctor who treated him after a surgery was unsuccessful was associated with a practice which provides chemo. However, the doctor clearly explained his options and made no attempt to make him continue chemo after he decided against it. Dr. Seay was very compassionate at that time and he and his team were very helpful in helping us to find a hospice facility and other support.
I'm currently being treated for lymphoma and while I don't agree with what a lot of you are saying I can understand your frustrations.
It's been my experience that one must work together with their team of doctors, insurance or not. I've seen first hand patients being sent home from the oncologist's office because of the inability to pay and it angered me to no end. But, these very same people were picked up my an angency because of the caring staff at the oncologist's office and they don't have to worry about the price of care, travel, etc.
My latest round of treatment was so much, I feel blessed to have insurance even though my husband pays a terribly high price for it.
Is it worth it? YES! Now it is.
Is it worth paying the oncologist so much? We'll see. I still have lymphoma and am expecting to start chemo soon.
Can someone please tell me the ballpark costs of these:
Taxol
Epirubicin
how sad this countrys health care is I am a 35yr old woman who was told she needed a biopsy of lymph nodes for lymphoma.I cannot afford insurance to see a surgeon I need 165.00 dollars just for a consultation!I also need to cone up with 50% of surgury cost 1 month before Xmas SCREW ME THANKS AMERICA
I have been treated for two different serious cancers; ovarian and kidney. I am also a nurse. Truly, I understand the depression, feelings of helplessness, frustration and anger that occur as a result of the cancer diagnosis and having to deal with the health care system.
Having cancer can also be a test of our personal strength. We can deal constructively with the situation by educating ourselves and discussing our information with our doctors, or we can become bitter, suspicious and beligerant. So many of the comments about physicians are mean-spirited. Oncologists have a difficult job. They do the best they can with a terrible disease. Sometimes they are successful. Many times, because of the virulence of the disease, there is little they can do except try various combinations of drugs or protocols. All of these drugs are very expensive because they are new. If the patient cannot afford the drug, social service departments or sometimes the nurse can refer you to drug company programs designed to assist those who cannot afford their chemotherapy. Sometimes, depending on your situation, title XIX can be used. Please do not be too discouraged. It doesn't help your health. Work to find a solution to your needs. There are social service agencies who help people like us.
Don't forget prayer. Whatever your religious preference, there is a Greater Power who loves you and will give you the strength you need.
It sure seems easy to blame the system on money. There are many factors...not just greedy doctors.
I have worked in the Biotech and Pharmaceutical arena for over 12 years now. This tenure has been in Sales & Marketing with many of the top companies in the industry. Coming from a family who's mother has been a Registered Nurse for over 35 years and a father who is a retired teacher of over 37 years, it is an essential part of me to help people - obviously, this stems from heredity, but ultimately is a huge part of me & what I morally feel is essential - it's the right thing to do. If we are fortunate enough, intelligent enough, and physically capable enough - it is our obligation to help others in need with no reward expected in return. After studying science for years & obtaining the necessary degrees, I chose to enter the business aspect of the pharmaceutical industry to make a difference. Regarding the blogs below on whether physicians are motivated by money, it is truly sad to say that MOST sincerely are...it's that simple. Many people & most of the public, demonize the biopharmaceutical industry as manipulative, money-making machines...this opinion is also widely shared by healthcare professionals. I will be the first to say that my industry is not without it's short-comings and faults. In fact, many things can be improved and over the years, I have personally focused on the best interest of the patient ...even at the risk of compromising my job. What I find appalling is the overall hypocrisy inherent across all aspects of the healthcare industry. I have personally witnessed countless physicians, hospitals, and professional associations use & manipulate the pharmaceutical industry for money. Not just a simple request for money, but for more & more money. The general problem here is that hospitals are a business, physician practices are a business, pharmaceutical companies are a business - and businesses need to make profits in order to survive. That's capitalism and that is the foundation of our country - right or wrong. The true question here is "What do we do about it??" I've witnessed time & time again, hospitals & physicians ordering unnecessary tests in order to maximize profits leeched from the managed care system and patients' pockets...I've witnessed countless times, the managed care companies intentionally denying valid patient claims knowing that most patients will not submit an appeal letter...I've witnessed time and time again, pharmaceutical companies devising a selling message with an intensional "spin" loosely based in science (all of which I refused to convey to doctors even at risk of my job)...I've witnessed countless physicians manipulating the system & drugs to maximize financial returns...With all that said, it would be naive to say that the US Healthcare system isn't flawed and money-motivated on every front. In light of this, I have been blessed to work with doctors & nurses who truly care about people & want to help, regardless of any profit. We need to cherish & reward these people - my mother is one of them. At the end of the day, many "bad-apples" ruin it for the few remaining "good-ones". We can only hope that the "good-ones" out shine the bad. Unless, or until, the US Healthcare System changes, each of us needs to stop & ask ourselves - "How can I help others?" Even when faced with the temptation of more money & greed, even when faced with the pressures of management urging you to make more money, "What will you do?"...Even in an imperfect system, we can ALL be perfect by making the RIGHT choices...and that is - helping others no matter the cost.
I was 39 when diagnosed with stage II breast cancer (mix of ILC & IDC). I had a single mastectomy. My onc wants me to have yearly diagnostic MRIs. However, the co-pay on my last MRI was $1,500! I have Blue Cross PPO. I told my doc: no more MRIs. In hindsight, if I had known how expensive the MRIs would be, I would have done a bilateral mastectomy.
Isn't it horrible that a woman thinks it would have been better to cut off a breast than spend the rest of her life worrying, all because she can't afford the best screening?
Mammogram missed the lobular portion of my cancer. So, I guess I'd better hope that if I have a new bilateral primary, it's invasive.
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