Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Friday, April 11, 2014

Naked Greed Laid Bare

"This is an enormous event. What it's going to help us do for the first time is figure out what these doctors actually do and what kinds of patients they actually see."
Bob Kocher, former special assistant to President Barack Obama for health-care policy

"[The information] will benefit not just consumers and the taxpayers but ultimately the health-care sector because it will shine some light in some dark corners where, frankly, health-care providers should improve the way they practise."
Joe Antos, American Enterprise Institute
Dr. Salomon Melgen
Mark Elias | Bloomberg | Getty Images  Dr. Salomon Melgen
The American Medical Association held that information relating to the earning of medical professionals should be kept private. According to the group's president, Ardis Dee Hoven, some doctors earn greater sums than their counterparts simply because they treat a disproportionately higher number of elderly patients. Or the cause can be linked to their expertise in a certain medical area, or that they achieve better health outcomes for their patients.

"Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences", stated Ms. Hoven, giving due warning.

Take, for example, Michael McGinnis, a New Jersey pathologist identified as the third highest remunerated in the Medicare data. Multiple doctors, under the system may be recorded under just one i.d. in the Medicare data leaving the impression that the one doctor recorded was receiving a suspect amount of payment. But as it happened, Dr. McGinnis's provider code was used to enable 27 doctors at Plus Diagnostics in Union, N.J., where he is medical director, apply for payment.

"I don't really work directly at the facility. I'm doing administrative work", Dr. McGinnis explained. Chalk that one up to misinterpretation. On the other hand, over 800,000 doctors in the Medicare program looking after the needs of the elderly and the disabled, showed a wide variance, when a federal judge last May lifted a 33-year-old injunction on that data after a lawsuit was launched and the Obama administration decided to make all payments public information.

The released data showed a concentration at the top with doctors making more than $1-million receiving thirteen times the $77,000 average paid by the Medicare program. The top 3% among doctors receiving payments collected over $17.6-billion; about $788,000 on average, with the remaining 802,711 individual health providers collecting an average of $58,000 each.

Cancer doctors specializing in blood work and radiation received the highest compensation, averaging over $360,000 annually, with ophthalmologists second on the list released by the U.S. Centers for Medicare and Medicaid Services. Fewer than 3% of recipients take in about 28% of the $64-billion paid out to individual health providers. Doctor fees account for 12% of Medicare's budget of $604-billion.

One Florida ophthalmologist received a whopping $21-million, 65 times the average in his field. He was found to have overbilled Medicare by $8.9-million, appealed and his appeal rejected. Another doctor, in jail since his August arrest, pleads not guilty to the charge of submitting false claims to Medicare for medically unnecessary services. He had billed patients in remission for chemotherapy, misdiagnosed patients as having cancer to justify chemotherapy and fabricated diagnoses to order hematology treatments.

The traditional bad apples in the barrels of credits to their profession.

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