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发帖数: 4091 | 1 Medicare Paid A Tiny Group Of Doctors A Whopping $1.5 Billion
Associated Press RICARDO ALONSO-ZALDIVAR, ASSOCIATED PRESS
APR. 9, 2014, 6:24 AM 773 1
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WASHINGTON (AP) — Medicare paid a tiny group of doctors $3 million or more
apiece in 2012. One got nearly $21 million.
Those are among the findings of an Associated Press analysis of physician
data released Wednesday by the Obama administration, part of a move to open
the books on health care financing.
Topping Medicare's list was Florida ophthalmologist Salomon Melgen, whose
relationship with Sen. Robert Menendez, D-N.J., made headlines last year
after news broke that the lawmaker used the doctor's personal jet for trips
to the Dominican Republic. Medicare paid Melgen $20.8 million.
AP's analysis found that a small sliver of the more than 825,000 individual
physicians in Medicare's claims data base — just 344 physicians — took in
top dollar, at least $3 million apiece for a total of nearly $1.5 billion.
AP picked the $3 million threshold because that was the figure used by the
Health and Human Services inspector general in an audit last year that
recommended Medicare automatically scrutinize total billings above a set
level. Medicare says it's working on that recommendation.
About 1 in 4 of the top-paid doctors — 87 of them — practice in Florida, a
state known both for high Medicare spending and widespread fraud. Rounding
out the top five states were California with 38 doctors in the top group,
New Jersey with 27, Texas with 23, and New York with 18.
In the $3 million-plus club, 151 ophthalmologists — eye specialists —
accounted for nearly $658 million in Medicare payments, leading other
disciplines. Cancer doctors rounded out the top four specialty groups,
accounting for a combined total of more than $477 million in payments.
Overall, Medicare paid individual physicians nearly $64 billion in 2012.
The median payment — the point at which half the amounts are higher and
half are lower — was $30,265.
AP's analysis focused on individual physicians, excluding about 55,000
organizations that also appear in the database, such as ambulance services.
None of those entities was paid $3 million or more.
The Medicare claims database is considered the richest trove of information
on doctors, surpassing what major insurance companies have in their files.
Although Medicare is financed by taxpayers, the data have been off limits to
the public for decades. Physician organizations went to court to block its
release, arguing it would amount to an invasion of doctors' privacy.
Employers, insurers, consumer groups and media organizations pressed for
release. Together with other sources of information, they argued that the
data could help guide patients to doctors who provide quality, cost-
effective care. A federal judge last year lifted the main legal obstacle to
release, and the Obama administration recently informed the American Medical
Association it would open up the claims data.
"It will allow us to start putting the pieces together," said Dianne Munevar
, a top researcher at the health care data firm Avalare Health. "That is the
basis of what payment delivery reform is about."
Doctors' decision-making patterns are of intense interest to researchers who
study what drives the nation's $2.8-trillion-a-year health care system.
Within the system, physicians act as the main representatives of patients,
and their decisions about how to treat determine spending.
The American Medical Association, which has long opposed release of the
Medicare database, is warning it will do more harm than good.
The AMA says the files may contain inaccurate information. And even if the
payment amounts are correct, the AMA says they do not provide meaningful
insights into the quality of care.
"We believe that the broad data dump ... has significant shortcomings
regarding the accuracy and value of the medical services rendered by
physicians," AMA president Ardis Dee Hoven said. "Releasing the data without
context will likely lead to inaccuracies, misinterpretations, false
conclusions and other unintended consequences."
The AMA had asked the government to allow individual doctors to review their
information prior to its release.
Over time, as researchers learn to mine the Medicare data, it could change
the way medicine is practiced in the U.S. Doctor ratings, often based on the
opinions of other physicians, would be driven by hard data, like statistics
on baseball players. Consumers could become better educated about the
doctors in their communities.
For example, if your father is about to undergo heart bypass, you could find
out how many operations his surgeon has done in the last year. Research
shows that for many procedures, patients are better off going to a surgeon
who performs them frequently.
The data could also be used to spot fraud, such as doctors billing for
seeing more patients in a day than their office could reasonably be expected
to care for.
Medical practice would have to change to accommodate big data. Acting as
intermediaries for employers and government programs, insurers could use the
Medicare numbers to demand that low-performing doctors measure up. If the
data indicated a particular doctor's diabetic patients were having unusually
high rates of complications, that doctor might face questions.
Such oversight would probably accelerate trends toward large medical groups
and doctors working as employees instead of in small practices.
Melgen, the top-paid physician in 2012, has already come under scrutiny. In
addition to allowing the use of his jet, the eye specialist was the top
political donor for Menendez as the New Jersey Democrat sought re-election
to the Senate that year.
Menendez's relationship with Melgen prompted Senate Ethics and Justice
Department investigations. Menendez reimbursed Melgen more than $70,000 for
plane trips.
The issue exploded in late January 2013, after the FBI conducted a search of
Melgen's West Palm Beach offices. Agents carted away evidence, but law
enforcement officials have refused to say why. Authorities declined to
comment on the open investigation.
___
Associated Press writer Kelli Kennedy in Miami contributed to this report.
Copyright (2014) Associated Press. All rights reserved. This material may
not be published, broadcast, rewritten, or redistributed.
Read more: http://www.businessinsider.com/medicare-doctor-payments-database-2014-4#ixzz2yOLpGgcB | d*****n
发帖数: 754 | 2 这已经是赤裸裸的腐败了。民主党在加速向天朝看齐。
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【在 c******i 的大作中提到】
: Medicare Paid A Tiny Group Of Doctors A Whopping $1.5 Billion
: Associated Press RICARDO ALONSO-ZALDIVAR, ASSOCIATED PRESS
: APR. 9, 2014, 6:24 AM 773 1
: inShare
: EMAIL MORE
: doctors
: Flickr/libertygrace0
: WASHINGTON (AP) — Medicare paid a tiny group of doctors $3 million or more
: apiece in 2012. One got nearly $21 million.
: Those are among the findings of an Associated Press analysis of physician
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