Intensity-modulated radiation therapy arrangements: Is geographic need the real reason?

Regarding the article, "Group challenges RT self-referral charges" (August 2010): Dr. Kapoor questions real data regarding self-referral concerns in in-office ancillary services (IOAS) arrangements for IMRT. Yet he states that a lot of patients will be adversely affected by legislation without citing any statistical data to back up this statement since it's impossible to measure the effect of something that has yet to occur.

Most IOAS setups involve large urology groups, which by their nature exist in geographic areas where cancer centers are already offering these services so that their emergence was not predicated on need at the onset. This, in itself, leaves a certain cause for concern regarding the validity of their reason to exist. Thus, Access to Integrated Cancer Care, the group that Dr. Kapoor leads, will have to spell out other reasons to exist, aside from geographic need, to strengthen its credibility.

Steven B. Roberts, MD
Tyler, TX

This data indicates that integrated urology groups cared for nearly 20% of Medicare beneficiaries in 2008, validating our statement regarding the potential negative impact of regulatory changes on the delivery of prostate cancer therapy. Further, the data that has been historically presented regarding radiation oncology is purely anecdotal, with any objective data based on utilization of diagnostic imaging, not therapeutic modalities. To extend data regarding diagnostics to therapeutics is breathtaking in its audacity and inappropriateness.

It behooves clinicians and regulatory agencies to carefully scrutinize subject-specific objective data regarding utilization prior to decision making, and to the extent that AICC has facilitated collection and distribution of that data, it has filled a critical niche since its formation. The physician members of AICC will continue to work to ensure patient access to comprehensive care of the highest quality.

Deepak A. Kapoor, MD
Melville, NY