Urologists who team up with pathologists appear to bill more, he said, leading to potential waste.
The new Medicare reimbursement coincided with urologists' loss of a major source of income.
Originally, it was seen as a drug that would be marketed only to urologists.
Over the years Radiation Therapy has bought out 30 gynecological oncologists, surgeons and urologists.
The insurance company covered a practice of eight urologists in Fort Myers that was having trouble getting coverage.
Because radiation oncologists do not diagnose cancer, they rely on referring physicians such as surgeons, urologists and gynecologists.
As a rule of thumb, urologists schedule vasectomies for Fridays and instruct patients to take the weekend to recover.
This move avoided any chance that the urologists might have bought their own radiation equipment--a trend sweeping the field.
Predictive Biosciences does not sell diagnostic equipment or test kits to urologists.
Urologists in practices with in-house pathologists sent 11.4 jars per biopsy for testing versus 5.9 jars per biopsy for other doctors in 2005.
The number of appointment requests spiked 30 percent in January 2009 on the Web site vasectomy.com, which links people with local urologists.
Throughout the 1990s, many urologists had supplemented their revenues through an arrangement with the maker of Lupron, a hormone drug for prostate cancer.
Deprived of the Lupron profits, some urologists' incomes declined by as much as one-half, according to several urologists who were practicing at the time.
At this point, most of the evidence of increased vasectomies has been anecdotal from practicing urologists, because there is no national registry for sterilizations.
Finally urologists have a legitimate technology on the medical side of things, something they can actually infuse in their offices to help their patients.
Under the arrangement, Lupron producer TAPPharmaceutical Products Inc. sold urologists the drug at a steep discount, while the urologists in turn billed Medicare for the full price.
"There has been a greater consideration on the part of many urologists to take less aggressive approaches with some low-grade cancer, particularly in older men, " Brooks said.
Some urologists said the research doesn't necessarily indicate financial motives.
But the operation was so demanding technically that most urologists were afraid to try it. (One doctor likens it to backing up a tractor trailer around a curve by looking through the rearview mirror).
In addition, urologists in recent years have been taking more samples during a biopsy to better identify the location of any cancer, said John Hollingsworth, an assistant professor of urology at the University of Michigan.
Urologists in larger group practices that have in-house pathologists may be more aggressive in testing because they seek to catch cancer earlier, said Steven Schlossberg, a Yale urologist who heads a health-policy panel for the American Urological Association and wasn't involved in the research.
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