Author: P Hasselbacher

Medicare Payments to Physicians and Other Providers: Analysis by Type of Provider.

Surprises, Disappointments, Confirmations, and Puzzles.

Most would agree, that transparency and accountability are in general, desirable. It does not necessarily follow however, that disclosure of previously hidden, obscure, or obtuse information arrives free of embarrassment for some or confusion for others. So it is with the recent unprecedented release by the Centers for Medicare and Medicaid Services (CMS) of the volume and cost of many of the services provided to some Medicare beneficiaries. Bothe the professional and lay media is fully energized with attempts to explain, excuse, or otherwise draw meaning from this voluminous and difficult-to-embrace set of data. Frankly, I have been rewarded with both surprise and disappointment, and with the satisfaction of solving puzzles. Clearly there is information here that both the professional and lay public must address if we are to benefit from a fair, effective, and efficient system of healthcare.

Ranking of Provider Types and Payments.
As a first step, I have broken down the 9+ million-item database by type of provider. There are 89 different types identified. (View the list here.) I attach 4 different PDF documents summarizing the same data in different views sorted by provider type, the number of individual providers in each provider type, the aggregate Medicare payments to each type, and the average payment for each provider of a given type. Please remember that there are many caveats attached to this data that must necessarily limit the conclusions that might be drawn. These are discussed by me in earlier articles of this series, and by others. Be that as it may, the view from 40,000 feet is instructive and shows us where to target more detailed analysis. Continue reading “Medicare Payments to Physicians and Other Providers: Analysis by Type of Provider.”

Catholic Health Initiatives Agrees to Pay $37 Million to Settle Class-Action Lawsuit for Angioplasty Abuse.

bemine2As reported in the Baltimore Sun last week, Catholic Health Initiatives (CHI) agreed to pay up to $37 million to settle civil claims of unnecessary coronary artery stenting at its St. Joseph Hospital in Towson, Maryland. The class action suit by some 273 patients was one of several federal and civil lawsuits against the hospital for the placement of, or billing for medically unnecessary invasive cardiac procedures beginning years before 2010. The settlement still needs the approval of court officials and an agreement of at least 60% of other plaintiffs to join the case. These and apparently other plaintiffs have the option not to join the settlement. The books are not obviously closed on the case. The Hospital’s principal invasive cardiologist, Mark G. Midei, is named in other open actions, but not this case.

Cost of doing business? Slap on the hand? Fair outcome?
Although this sounds like a lot of money, it amounts only up to $134,000 per patient before plaintiff’s attorneys take 40% and repayments are made to Medicare, Medicaid, and private insurance companies who paid for the “allegedly” unnecessary medical procedures. Frankly, I anticipated a higher penalty given my understanding of the severity of the “alleged” deeds. Naturally, as we have come to see in these cases, CHI admits no wrongdoing, presumably knuckling under to an alternative interpretation of heavy-handed litigation and to avoid further uncertainty and legal expense.

CHI settled earlier with the Federal Government for $22 million for illegal kickbacks. In May 2013, the Hospital settled confidentially with another 200 or so patients for unknown sums. CHI sold its unfortunately but inevitably-tainted hospital (but not its tort liabilities) to the University of Maryland in 2012. In my opinion, and based on what I have read from independent examination of the facts, including a US Senate investigation, I would not personally have visited the hospital for services. Regretfully, when all the facts in cases like this are kept from the public, confidence and trust can be lost for a long time. No one is served well, save perhaps attorneys for the plaintiffs. Continue reading “Catholic Health Initiatives Agrees to Pay $37 Million to Settle Class-Action Lawsuit for Angioplasty Abuse.”

Analysis of CMS Release of Medicare Provider Payments Begins!

Both aggregate and detailed data for Kentucky and Louisville available for download below.

Its out there!
The release last week by the Centers for Medicare and Medicaid Services (CMS) of services by and payments to physicians and other non-hospital providers reverberated as expected throughout the nation. Analysis of the massive database is, and will continue to expose the complexity, quirks, inequities, fraud, and sometimes just plain bizarreness in our current health care system. Some large media outlets such as the New York Times, the Wall Street Journal, and the Washington Post were allowed to organize and work with the data before it was released to the general public. Both these sites and perhaps others allow the public to look up individual providers, but comparisons of individuals or groups is cumbersome to impossible. Furthermore, neither of these two portals to the data includes all non-physician providers. In any case, a host of individual providers or professional groups are now scrambling to try to explain why they stick out like sore thumbs in terms of frequency of services, charges, or payments from Medicare.

Eye doctors (and others) under the magnifying glass.
For example, ophthalmologists point out that the reason they receive among the highest payments is that they frequently inject an extremely expensive drug into the eyeball. While this may be rational and honest defense, it is not a reasonable one if, as is reported, it is true that a spectacularly cheap alternative generic drug works just as well. Thus, the issue of how much money a physician or other provider is entitled to make off a drug they chose to administer themselves is certain to enter public debate. Continue reading “Analysis of CMS Release of Medicare Provider Payments Begins!”

Governor Steve Beshear Exercises Line-Item Vetoes on State Budget.

Gov. Beshear used his line-item veto on the state budget passed by the General Assembly to alter two higher-education education items. They relate to the Kentucky Community and Technical College System, and to the University of Louisville.

With regard to the former, the Governor altered language with the intent of giving more leeway to the governance of KCTC to use agency bonds and fees to fund capital projects on their campuses. With regard to the latter, the Governor reduced the University’s role in evaluating its own need for QCCT funding for indigent care or the effect of the reduction in the amounts appropriated. Continue reading “Governor Steve Beshear Exercises Line-Item Vetoes on State Budget.”