Self-referral and the role of IMRT in treatment of prostate cancer

The issue of whether some urology practices are investing in equipment capable of delivering intensity-modulated radiation therapy (IMRT) with financial motives is back on the front burner again.

An article in today’s Baltimore Sun pretty much accuses a particular urology practice of investing in IMRT equipment for financial gain and self-referring patients for IMRT rather than other forms of treatment.

The “New” Prostate Cancer InfoLink has no interest in getting in the middle of this debate, but it will simply ask why a medical practice run by urologists (who have no expertise in radiation therapy for the treatment of prostate cancer) would go out and invest a lot of money in radiation therapy equipment unless they thought it was a financially profitable opportunity?

Patients who are referred to a radiation oncology center that is owned by the practice making the referral might want to ask some really hard questions before they let themselves be taken advantage of.

4 Responses

  1. On the other hand, what if the urologists hired radiation specialists to operate the radiology practice?

    Like an academic institution which can offer quality treatment in both surgery and radiation, a referral to one or the other might result in the same profit margin to the practice, and cause the practice to make the referral based upon the patient’s needs and best treatment option, rather than profit motive. Maybe hiring radiation specialists is phase II of the urologist’s business plan??

  2. Do these urology groups hire radiation oncologists to perform the radiation?

    If so, despite the group expanding to own IMRT equipment, the service is provided by qualified radiation oncologists on staff. It stands somewhat to reason that such a “medical business” wants to improve both their income as well as what they can offer their patients. It is nothing new that patients should have a choice of treatment options that include either surgical removal of or radiation to the prostate gland. We encourage patients to visit with urologists and radiation oncologists to learn of the options provided and come to their own decision as to what option they would prefer.

    If patients of such urology groups were explained their various options and chose IMRT — or even PBRT — over surgical removal, and the group has appropriate equipment and radiation oncologists to perform that option, what is unethical in this business venture? Hospitals, as a business, invest in da Vinci equipment, CyberKnife equipment, Proton beam equipment, and IMRT and other enhancements to increase their profits, so I see no conflict of interest for Urology groups to do the same.

    The news article states “Independent or hospital-based radiation oncologists don’t have the power to inflate medical bills by ordering possibly unneeded IMRT procedures. They don’t prescribe the treatment. Urologists who own IMRT accelerators do.” Who is to say that the urology groups are “ordering possibly unneeded IMRT procedures? These may very well be the patients’ choice when explained their treatment options. And who is to say that patients referred by a urologist to hospital-based or independent radiation oncologists to discuss a radiation option are not encouraged by those radiation oncologists to be treated with photon or proton radiation despite possibly not needing such procedures?

    Personally, I see the expansion of urological facilities to offer other treatment options on site as simply a business venture as long as the appropriately qualified physicians are part of the staff. If any investigation is to be performed, it should be going to patients to determine if they were steered to and encouraged to a particular treatment option or if that option was THEIR choice.

  3. Dear Richard and Chuck:

    Naturally urology practices hire radiation oncologists to run these IMRT facilities. Urologists don’t know how to do radiation therapy.

    BUT … If your urologist tells you, “You know, I could operate on you, but I really think that you would do better with IMRT,” how many patients do you think will understand what is going on?

    The next step will be radiation oncology groups hiring surgeons and buying da Vinci equipment!


  4. My guess is there will be an extraordinary uptick in men suddenly in desperate need of second-line therapy, particularly if a physician’s group owns or is partnered with a pathology laboratory too.

    It would sure be interesting to see what happens to both biopsy and post-surgical pathology outcomes for practices with a financial interest in delivering as much “service” as they possibly can. Too bad they’re not adding active surveillance specialists, physical therapists, and penile rehabilitation specialists. Then patients would have a shot at a win too. I guess it’s not as profitable to manage people with diverse ideas about prostate cancer as it is depreciate new equipment in the world of one-chop-shopping.

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