Local urologist on the hot seat

Amir Saffarian

A Morgan Hill urologist is linked to a Salinas clinic that is being investigated by federal regulators for prescribing prostate cancer patients an expensive, often unnecessary form of treatment primarily for financial gain, according to a recent investigative news report.

Dr. Amir Saffarian, whose practice is located in the DePaul Health Center in north Morgan Hill, was cited in a report by Bloomberg News as having prescribed Intensity-modulated Radiation Therapy – a high-tech treatment costing upwards of $40,000 per patient in some states – to at least one patient who might not have needed it.

Saffarian said in response to the report that he has never made a referral to any patient for financial reasons.

According to the report published Nov. 5, Saffarian referred Salinas patient Max Calderon to the Salinas Valley Urology Associates for a series of eight-week treatments after he was diagnosed with prostate cancer in 2010.

Saffarian, as an associate of the clinic, reportedly billed Medicare and Medicaid $30,000 for Calderon’s treatment.

Calderon, a retired construction worker, died in August at the age of 79, according to the Bloomberg report.

Now, the Salinas clinic is among other IMRT providers who are under scrutiny by the U.S. Department of Health and Human Services for referring patients to IMRT not because it is the best option to combat their cancer, but because doctors are paid more for radiation therapy than for other treatments, according to Bloomberg News.

IMRT uses advanced technology to direct radiation beams toward cancerous tumors on the prostate. The high-tech treatment nets the prescribing doctor a higher rate of reimbursement from Medicare, Medicaid and private insurers than other treatments, according to Bloomberg News and other investigative studies conducted on IMRT in recent years.

The lengthy report by Bloomberg News cites a list of studies and experts, as well as some other former patients of the Salinas clinic, who claim that IMRT is on the rise in recent years. The increase is tied to the growing number of doctor-owned private clinics that have made expensive investments in IMRT technology in order to treat patients on-site, according to the report.

Saffarian declined to comment on Calderon’s case, or to acknowledge that Calderon was his patient, citing federal and state laws that protect patients’ privacy and medical records.

However, he noted that IMRT is an accepted and effective form of treatment for prostate cancer, and denied that he would recommend any form of treatment for financial purposes.

“I do not refer patients for this or any other therapy unless I believe it is in their best medical interest,” Saffarian said. “I believe my treatment of all my patients has been consistent with the best medical and ethical practices.”

The U.S. Department of Health and Human Services did not respond to requests to confirm that an investigation into the use of IMRT is underway.

Salinas Valley Urology Clinic’s owners, Dr. Stephen A. Worsham and Dr. Aytac Apaydin, called Bloomberg’s report “misleading” and said they are “surprised and disappointed” with the conclusions made in the report.

The report, as well as a number of local press reports that have followed up on Bloomberg’s investigation, “had the facts wrong,” the Salinas doctors claim.

“We provide thorough and compassionate diagnostic and treatment services to our patients,” a press release from the owners of Salinas Valley Urology Associates said. “All of our patients who require medical treatment are fully informed of their treatment options. Decisions regarding medical therapy are entirely their own and the physicians and staff at Salinas Valley Urology Associates honor and respect our patients’ decisions.”

While Saffarian is not listed as an owner of Salinas Valley Urology Associates, his name is one of a dozen doctors listed on a sign outside the clinic at 1115 Los Palos Drive in Salinas, along with Worsham and Apaydin, according to the Bloomberg report.

Staff at the clinic declined to provide further comment to the Times other than the press release.

The Salinas clinic’s website also says it is “affiliated with” Saint Louise Regional Hospital in Gilroy.

Saint Louise Regional Hospital spokeswoman Jasmine Nguyen explained that doctors such as Saffarian who treat patients at the hospital are not employed there and are “independent, private” physicians.

“They’re all independent doctors, who have privileges to admit patients to the hospital,” Nguyen said.

Prostate cancer is the second most common form of cancer for men in the U.S. (behind skin cancer), according to the nonprofit Mayo Clinic’s website. The disease starts in the prostate and can spread to other organs or result in other illnesses if left untreated.

IMRT is one of several treatment options for prostate cancer, according to the Mayo Clinic. Other treatment options include “watchful waiting,” hormone therapy, surgery, ultrasound and chemotherapy.

Best treatment options are determined on a case-by-case basis, based on individual doctors’ evaluations and an extensive set of guidelines established by the National Comprehensive Cancer Network and other experts.

The Salinas clinic offers an array of prostate cancer screening and treatment services, including IMRT, x-rays and CT scans, surgery and lab studies, according to its website.

The investigative reports by Bloomberg and other media outlets do not deny that IMRT is an effective, approved and accepted form of prostate cancer treatment, but claim that it might be overused, and many of its recipients might have benefited equally or more so from other, less expensive forms of treatment.

In 2008, Medicare spent about $1 billion on IMRT, according to an investigative study on the practice published by the Wall Street Journal in 2010. And Medicare payments for IMRT can reach up to $40,000 per patient in some states.

By contrast, Medicare reimburses doctors up to $16,000 per patient for surgery to remove the prostate, and up to $19,000 for another form of radioactive treatment, according to the Wall Street Journal report.

As of 2010, about one-third of prostate cancer patients received IMRT, the Wall Street Journal reported. Eight years ago, hardly any patients received IMRT, and the Journal ties this increase to the rise of “self referral” cases.

While federal laws prohibit doctors from prescribing treatments for financial incentive, some urologists have taken advantage of loopholes in the laws to do just that, the Journal reported. These urologists get together to purchase the radiation equipment and hire oncologists to conduct IMRT, then refer their patients to their clinics which are owned by groups of physicians.

Salinas Valley Urology Associates is one such group, according to Bloomberg News, though the Salinas clinic denied seeking financial incentives and limiting patients’ options.

Some of the comments submitted to the Bloomberg story on the news organization’s website attempt to refute the report’s conclusion that the Salinas urologists are working the system for financial gain. These include comments from patients of the clinic who received IMRT and say the treatment saved their lives.

An expert quoted in the Bloomberg story – assistant professor of urology Dr. Matthew Cooperberg with the University of California, San Francisco – said some of his comments were “taken out of context” in that report.

He told the Times that “urology is not the source of the problem.” Rather, the problem stems from the vast difference between reimbursement rates for IMRT, which he said has not proven to be more effective than other treatments for prostate cancer such as surgery.

“In my mind, the solution is to bring the payments in line with other treatments,” Cooperberg said. “If we were in that sort of system, a lot of these imbalances would work themselves out.”

There is no doubt that health care costs are continually on the rise in the U.S. – for numerous reasons – and a significant portion of this rise is attributed to cancer treatment, according to the National Cancer Institute.

According to that institute’s website, medical expenditures for cancer are projected to rise from about $125 billion in 2010 to about $158 billion in 2020 – a 27-percent jump. Costs for prostate cancer are projected to rise from about $12 billion to about $16 billion in the same period.

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