Chart of the day: Prostate cancer treatment “selfies”

Today’s chart comes from the recent GAO report on delivery of intensity-modulated radiation therapy (IMRT) for prostate cancer among Medicare patients by physician groups that do and do not self-refer (h/t Karan Chhabra). Self-referring here means that providers administering IMRT had a financial relationship with the entity that referred the patient for the therapy.

Surprise! Self-referring groups are a growing source of IMRT delivery; non-self-referring groups are not. Remuneration does not imply causation, but the findings are consistent with the idea that physician groups respond to financial incentives.

GAO self-ref

Some other facts from the GAO report:

  • Providers are not required to disclose that they self-refer.
  • IMRT is one of the more costly prostate cancer treatment options, but not clearly superior.
  • Other work has documented that physicians play a large role in determination of a patient’s prostate cancer treatment approach.
  • Other work has also suggests financial incentives may influence treatment decisions.
  • Differences between self-referring and non-self-referring providers shown above could not be explained by differences in age, geographic location, or health.


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