title: Are Small Reimbursement Changes Enough to Change Cancer Care? Reimbursement Variation in Prostate Cancer Treatment.
abstract: OBJECTIVE
  The Centers for Medicare and Medicaid Services recently initiated small reimbursement adjustments to improve the value of care delivered under fee-for-service. To estimate the degree to which reimbursement influences physician decision making, we examined utilization of gonadotropin-releasing hormone (GnRH) agonists among urologists as Part B drug reimbursement varied in a fee-for-service environment.
  
  
  METHODS
  We analyzed treatment patterns of urologists treating 15,128 men included in SEER-linked Medicare claims who were diagnosed with localized prostate cancer between January 1, 2000, and December 31, 2003. We calculated a reimbursement generosity index to measure differences in GnRH agonist reimbursement among regional Medicare carriers and over time. We used multilevel analysis to control for patient and provider characteristics.
  
  
  RESULTS
  Among urologists treating early-stage and lower grade prostate cancer, variation in reimbursement was not associated with overuse of GnRH agonists from 2000 to 2003, a period of guideline stability (odds ratio, 1.00; 95% CI, 0.99 to 1.00).
  
  
  CONCLUSIONS
  Small differences in androgen-deprivation therapy reimbursement generosity were not associated with differential use. Fee-for-service reimbursement changes currently being implemented to improve quality in fee-for-service Medicare may not affect patterns of cancer care.
authors.affiliation: University of Kansas School of Medicine, Kansas City, KS; University of North Carolina at Chapel Hill, Chapel Hill; Durham Veterans Affairs Medical Center; and Duke University Medical Center, Durham, NC sellis4@kumc.edu.
authors.forename: Shellie D
authors.initials: SD
authors.lastname: Ellis
authors.affiliation: University of Kansas School of Medicine, Kansas City, KS; University of North Carolina at Chapel Hill, Chapel Hill; Durham Veterans Affairs Medical Center; and Duke University Medical Center, Durham, NC.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Chen
authors.affiliation: University of Kansas School of Medicine, Kansas City, KS; University of North Carolina at Chapel Hill, Chapel Hill; Durham Veterans Affairs Medical Center; and Duke University Medical Center, Durham, NC.
authors.forename: Stacie B
authors.initials: SB
authors.lastname: Dusetzina
authors.affiliation: University of Kansas School of Medicine, Kansas City, KS; University of North Carolina at Chapel Hill, Chapel Hill; Durham Veterans Affairs Medical Center; and Duke University Medical Center, Durham, NC.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Wheeler
authors.affiliation: University of Kansas School of Medicine, Kansas City, KS; University of North Carolina at Chapel Hill, Chapel Hill; Durham Veterans Affairs Medical Center; and Duke University Medical Center, Durham, NC.
authors.forename: George L
authors.initials: GL
authors.lastname: Jackson
authors.affiliation: University of Kansas School of Medicine, Kansas City, KS; University of North Carolina at Chapel Hill, Chapel Hill; Durham Veterans Affairs Medical Center; and Duke University Medical Center, Durham, NC.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
authors.affiliation: University of Kansas School of Medicine, Kansas City, KS; University of North Carolina at Chapel Hill, Chapel Hill; Durham Veterans Affairs Medical Center; and Duke University Medical Center, Durham, NC.
authors.forename: William R
authors.initials: WR
authors.lastname: Carpenter
authors.affiliation: University of Kansas School of Medicine, Kansas City, KS; University of North Carolina at Chapel Hill, Chapel Hill; Durham Veterans Affairs Medical Center; and Duke University Medical Center, Durham, NC.
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000191:economics / Q000627:therapeutic use; D018588:Fee-for-Service Plans; D007987:Gonadotropin-Releasing Hormone / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D005791:Patient Care / Q000191:economics* / Q000379:methods*; D010818:Practice Patterns, Physicians'; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000628:therapy; D012051:Reimbursement Mechanisms / Q000191:economics*; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone