Journalists have had a good time with the Medicare data on payments
to doctors. The most recent exposé is headlined "Taxpayers face big
Medicare tab for unusual doctor billings" by the
Wall Street Journal. Because
of a paywall, most people did not have a chance to read the article.
It recounted several anecdotes about physicians who received
huge amounts of money for procedures of dubious worth. I will summarize two of
them.
In 2012, an internist in Los Angeles was paid close to $2.3
million for a procedure known as "enhanced
external counterpulsation," or EECP, which is supposed to ameliorate
angina in patients who are not surgical candidates.
Although not a
cardiologist, he apparently used EECP on 615 patients. At the Cleveland Clinic,
whose chairman of cardiology says the procedure should rarely be used, the
procedure was performed on only 6 patients in a year—that's 6 patients total by a staff of 141 cardiologists.
A Florida dermatologist received $2.41 million from Medicare
in 2012 for 15,610
radiation treatments for melanoma in 94 patients, an average of 166 treatments per patient. The usual number is 20 to
35 treatments. The doctor said he billed for each lesion separately and treated
each one about 40 times.
A
radiation oncologist who was interviewed questioned the appropriateness of the machine the dermatologist was using and said, "When a patient has several lesions, they commonly get treated
simultaneously and are billed for as a single treatment, he said."
That is the way
Medicare handles most multiple procedures. At best you might get away with
billing a partial amount for an additional treatment.
Any physician who has spent time in the private practice of
any medical specialty that involves the treatment of elderly patients can tell
you that Medicare will nickel and dime you to death over a minor dispute about
an evaluation and management code.
Medicare is also notorious for holding back money due to
physicians who are just trying to make a living. A classic ploy is to request a
copy of the dictated operative note for a simple procedure. This will add 4 to
6 weeks to the eventual cutting of a check.
They routinely perform unannounced on-site audits of doctors
offices looking for discrepancies in documentation. I once experienced one
myself and luckily was not cited or fined.
Here are some questions that I haven't seen any journalist
ask.
Why does the Wall Street Journal have to point out such
flagrant outliers? What does the Wall Street Journal know about detecting these
practices that Medicare could not do for itself? How can Medicare continue to
pay top dollar for questionable treatments and billing practices? Why doesn't
Medicare do something simple like automatically reviewing any practice that
receives more than say $500,000 in a single year?
Inquiring minds want to know.
What's your opinion?
