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The geographic cost index is positive, but statistically significant and relatively large in magnitude only in the BCSRT versus MST comparison.
Leaving out the procedure mix variables has virtually no effect on the BCSRT estimates, but reduces the BCSO fee coefficients by about one-third.
Nonwhite beneficiaries are 1.8 to 2.0 times more likely than white beneficiaries to receive BOSO relative to MST or BCSRT, but only slightly less likely to receive BCSRT relative to MST.
We addressed many of the potential limitations and sources of bias in the earlier analysis by using data for individual women with confirmed diagnoses of early-stage breast cancer, by isolating the effect of variations in pure fees, by distinguishing between BCSRT and BCSO, and by controlling directly for the effects of prior health condition and disease stage.
We found that Medicare fees were significant factors in the choice between MST and BCSRT, but did not significantly influence the choice of BCSO versus MST.
If this inference is valid, then our earlier study, which could not distinguish BCSO from BCSRT, may have understated the effects of Medicare fees by combining BCSO and BCSRT cases.
We also found that the treatment received may be influenced by BCS and MST intraprocedure "practice styles." Women were more likely to receive BCSRT in areas where the high-fee BCS procedure (code 19 162- removal of breast lesion and axillary nodes) was a relatively high proportion of Medicare BCS procedures.
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