Study: Surgical Volume & Costs Grow After Medicare Payment Change

Researchers say reimbursement boost meant to cut costs may have caused over-utilization.

When Medicare increased reimbursements for outpatient endoscopic bladder procedures a few years ago, its intent was clear: to cut costs by shifting bladder cancer treatment to the less expensive office setting. But a new study shows that this move appears to have backfired. The number of outpatient bladder surgeries increased significantly after the 2005 payment change, but the number of hospital-based procedures didn't decline significantly, leading to a 50% rise in Medicare costs.

Researchers from the Division of Urologic Oncology at the New York University Langone Medical Center studied treatment patterns from 2002 through 2007 and observed the following trends after the 2005 payment change:

# The number of outpatient bladder surgeries doubled.

# The likelihood that an outpatient bladder surgery would lead to a bladder cancer diagnosis declined.

# The number of hospital-based surgeries did not decline significantly.

# The likelihood of repeat surgery on the same lesion increased.

"We believe these trends are disturbing as they may reflect both diagnostic and therapeutic over-utilization of office-based endoscopic bladder surgery," write the study's authors in the journal Cancer. Lead author Micah Hemani, MD, says the results indicate a need for both clinical guidelines for office-based bladder surgeries and policies that hold the physicians who perform them accountable.

Irene Tsikitas