The Complex Calculations of Cancer Care

Any organization with the money and resources to do so can buy cancer diagnosis and treatment technologies, Agarwal says. “But to utilize the technologies properly is very important.”

Getting a grip on cost, utilization
It takes effort to keep costs down and avoid unnecessary tests and procedures, Datta says. But spending time explaining to patients the reason you are not going to give them the procedure they want doesn’t make business sense, he says. “I’m spending time on something that is just not necessary.”

So while educating patients about their options is important, it’s even more important to educate referring physicians and radiologists about overtesting. Too often, he says, a patient goes to his or her doctor for a head cold or a stomachache and leaves the office having had his or her full cancer biomarkers drawn. Datta says the tide of overtesting must be stemmed before the patient even walks into the doctor’s office. “Once you diagnose a cancer, there’s nothing you can do to dissuade the patient from seeking treatment,” he says.

Datta follows testing guidelines from the National Comprehensive Cancer Network and works with radiologists who share his clinical philosophy. They work to come up with a recommendation that is “more sensible than biopsy, biopsy, biopsy,” he says.

“You’ve got to be on top of technology not only to deliver the medicine to a small percentage of patients, but also to keep the other 75% who may not need it,” Datta says. “I think technology is definitely worth it because it does help to treat things more precisely to our patients. It is helpful. All I’m saying is that if we can save money on the number of investigations and biopsies and procedures that we do, we can put more effort into patients that have been diagnosed and treat them appropriately.”

Many Factors Lead to Overutilization
Oncologists and physician leaders say that the sticker price of treatments and technology is just part of the reason cancer care is so expensive. Defensive medicine prompted by fear of lawsuits, pressure from patients who want the most cutting-edge treatment, and the effect that advanced treatment offerings have on an organization’s reputation and volume all contribute, too.

In fact, the 2010 HealthLeaders Media Industry Survey asked physician leaders what influences their decisions to order tests or procedures. The most common “major influence” was fear of lawsuits and defensive medicine (about 33%). About 30% said reimbursement and revenue considerations influence their decisions. And 27.5% said pressure from patients was a major influence.

It’s easy to blame expensive technology or balk at the cost of new drugs, says Anurag Agarwal, MD, chief of radiation oncology at Broward Health, a seven-hospital system in Fort Lauderdale, FL. “Absolutely focus on the technology and the new drugs and the new gene therapies and everything that is coming out, but also focus on the flip side of it,” he says. “Focus on tort reform, focus on things that are occurring to drive up healthcare costs, to cause defensive medicine ? Try to address the bigger picture, not just one piece.”