Reimbursement Changes in Office Endoscopies Studied

Study finds higher reimbursement increases in-office bladder procedures and Medicare costs
By Jeff Muise
HealthDay Reporter

TUESDAY, Feb. 9 (HealthDay News) -- A 2005 increase in Medicare reimbursement to encourage office-based endoscopic surgeries for bladder cancer instead of more costly hospital surgeries had the unintended effect of disproportionately increasing in-office procedures and driving up Medicare costs, according to a study published online Feb. 8 in Cancer.

Micah L. Hemani, M.D., of New York University in New York City, and colleagues used Medicare billing codes to identify 1,341 office-based and hospital-based endoscopic bladder surgeries performed in one practice from 2002 through 2007. The researchers analyzed the impact of the Medicare reimbursement increase on practice patterns and costs.

Following the 2005 reimbursement change, the researchers found that the odds of endoscopic surgery taking place in the office during cystoscopy and of a surgery taking place in the office instead of the hospital both more than doubled (odds ratios, 2.01 and 2.29, respectively). For lesions associated with bladder cancer and non-bladder cancer, the odds of an office-based versus hospital-based procedure also increased substantially (odds ratios, 1.36 and 1.99, respectively). The authors note that the changed practice patterns increased Medicare spending an estimated 50 percent.

"The report by Hemani and colleagues in this issue of Cancer illustrates that well intentioned changes in health policy often have unintended consequences and ultimately may result in the exact opposite of what policymakers intended," writes the author of an accompanying editorial.

One author reported serving as a consultant or advisory board member for several medical and pharmaceutical companies.

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