Medical Oncologists' Perceptions of Financial Incentives in Cancer Care

Authors

Jennifer L. Malin

Jennifer L. Malin, Jonsson Comprehensive Cancer Center and David Geffen School of Medicine at University of California at Los Angeles and Greater Los Angeles VA Healthcare System, Los Angeles, CA; Jane C. Weeks, Dana-Farber Cancer Institute; Nancy L. Keating, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Arnold L. Potosky, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; and Mark C. Hornbrook, Center for Health Research, Kaiser Permanente Northwest, Portland, OR.

Jennifer L. Malin, Jane C. Weeks, Arnold L. Potosky, Mark C. Hornbrook, Nancy L. Keating

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Purpose

The cost of cancer care continues to increase at an unprecedented rate. Concerns have been raised about financial incentives associated with the chemotherapy concession in oncology practices and their impact on treatment recommendations.

The objective of this study was to measure the physician-reported effects of prescribing chemotherapy or growth factors or making referrals to other cancer specialists, hospice, or hospital admissions on medical oncologists' income. US medical oncologists involved in the care of a population-based cohort of patients with lung or colorectal cancer from the Cancer Care Outcomes Research and Surveillance (CanCORS) study were surveyed regarding their perceptions of the impact of prescribing practices or referrals on their income.

Although most oncologists reported that their incomes would be unaffected, compared with salaried oncologists, physicians in fee-for-service practice, and those paid a salary with productivity incentives were more likely to report that their income would increase from administering chemotherapy (odds ratios [ORs], 7.05 and 7.52, respectively; both P < .001) or administering growth factors (ORs, 5.60 and 6.03, respectively; both P < .001).

A substantial proportion of oncologists who are not paid a fixed salary report that their incomes increase when they administer chemotherapy and growth factors. Further research is needed to understand the impact of these financial incentives on both the quality and cost of care.