A new study documents a sharp rise in office-based procedures for bladder cancer after the Centers for Medicare and Medicaid Services (CMS) boosted physician reimbursement for these procedures. The study also found no commensurate drop in hospital-based procedures.

Investigators examined the billing database of a 10-physician faculty practice at New York University between 2002 and 2007. The number of office-based bladder cancer procedures increased from 227 before the CMS rules went into effect to 537 afterwards.

Following adjustment for practice growth, the researchers determined that the number of procedures rose by 201%, according to a report in (Cancer 2010;116:1264-1271). At the same time, researchers observed a 12% growth-adjusted reduction in the number of hospital-based interventions.

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The investigators, led by Samir Taneja, MD, Director of the Division of Urologic Oncology at New York University School of Medicine, also found a drop in the likelihood that a biopsy in the post-change period would lead to a diagnosis of cancer. In addition, the researchers identified an 18-fold absolute cost increase for office-based procedures compared with only a 3% for hospital-based procedures. The investigators “strongly suspect” similar trends have occurred nationwide.

“The implication is that practice changes or reduced threshold for biopsy are, at least in part, driven by financial incentive,” Dr. Taneja told Renal & Urology News. “To address this would require not only redistribution of dollars, but also development of evidence-based clinical guidelines, and methods of measuring quality of care when evaluating billed services.”

In an accompanying editorial (pp.1153-1154), David Penson, MD, MPH, of the Department of Urologic Surgery at the Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, praised the investigators for presenting their own practice patterns. Dr. Penson said he agreed that the researchers’ findings likely represent a nation-wide phenomenon, but also noted the current health care debate is not all about cost.

“Quality and access are important aspects that also must be considered,” he wrote. “By incentivizing providers to perform bladder biopsies in the clinic, policymakers inadvertently may have increased costs, but they also may have improved access, which is an important and laudable goal. The increased access may result in earlier detection of bladder tumors, perhaps better outcomes, and even cost savings down the line.”

He called for studies examining whether the additional bladder biopsies were appropriate and altered outcomes.