Cutting physician reimbursement might curb potentially inappropriate use of prostate cancer therapy and lower health care costs.

University of Florida urologist Scott Gilbert, M.D., M.S., and colleagues at the University of Michigan and the University of Texas Medical Branch, evaluated national patterns of how doctors prescribed a hormone treatment called androgen deprivation therapy, before and after the Centers for Medicare and Medicaid lowered the associated rate at which it reimbursed doctors (NEJM 363(19):1822-32, 2010). Among people for whom the treatment was considered necessary, there was no decline in use when payments became less. In contrast, use of the therapy fell more than 30 percent among patients for whom there is no medical evidence that it is beneficial. Paying physicians less for a commonly-administered prostate cancer therapy can help curb inappropriate use without preventing use among people who need it, and at the same time save health care dollars.