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!”

Medicare Payments to Physicians Now Available On-Line.

Take a look at the results for Louisville and Kentucky.

Our colleague Terry Boyd at Insider Louisville was probably the first out of the block this morning to report on the local results of the much-debated, long-opposed, and likely system-changing publication by the Centers for Medicare and Medicaid Services of the amounts of money charged by and payed to individual physicians and other providers for some Medicare patients. This previously top-secret financial and utilization information had not even been available to other physicians let alone the public.

Long opposed by organized medicine as a violation of individual physician privacy, the public has gotten used to, indeed gained an appetite for such information about hospitals, nursing homes and the like. This is part of the movement to increase medical safety, quality, and efficiency. It also has been very helpful for identifying medical fraud and abuse. I predict that the release of physician payment data will have as much earth-shaking effect as last year’s release of hospital payment data illustrated by the now-famous article in Time Magazine, “Bitter Pill: Why Medical Bills Are Killing Us,” by Steven Brill.

There will be much to learn from this extensive database. It is huge! My tricked-out Mac chokes on the size of it. You can look up individual physicians for a more detailed breakdown on the Washington Post Portal referred to by Terry Boyd, or the Wall Street Journal..  To give the community something to look at while I do the same, a more manageable aggregate list of all the physician and other non-hospital Medicare providers doing business in Louisville or the state of Kentucky is available below.  I have ranked the lists by the amount of money actually paid to individual providers– highest paid providers are at the top. Definitions of the individual items and some other comments about the data are present in the designated tabs. Continue reading “Medicare Payments to Physicians Now Available On-Line.”

QCCT Fund for Indigent Care Takes a Further Beating in Kentucky Senate.

As reported in these pages earlier, the Governor’s budget (and that of the House) decreased QCCT funding for indigent care at University Hospital by 70% percent over the next two years. The justification for this decrease was that the new healthcare reforms being put into place would result in fewer patients showing up for care at Louisville’s designated poor-people’s hospital. Perhaps there were other reasons too.

QCCT gets zeroed out.
The Senate’s Budget Committee upped the ante by immediately eliminating this subsidy altogether! Senate Republicans justify this further decrease with an amazingly cynical bit of political sophistry. Senate Republicans argue that because every person in Kentucky is now eligible for some form of health insurance, that no patient will be eligible for QCCT funding in any case. Some folks may actually believe this. Of course not even the most ardent defenders of the Accountable Care Act (ACA) claim that everyone will be covered by the complicated system of programs and options that could be cobbled together against intense partisan opposition. Among other reasons, out-of-pocket costs to patients will still present a prohibitive barrier for many. Failure to fund the full “traditional” $21 Million program releases University Hospital from its obligation to provide care to all comers. There will still be plenty of work to go around for all Jefferson County providers to take their share. Continue reading “QCCT Fund for Indigent Care Takes a Further Beating in Kentucky Senate.”

St. Joseph’s London Discontinues Coronary Artery Bypass Surgery.

St. Joseph’s London Hospital has notified the state that it will no longer perform coronary artery bypass graft surgery (CABG), the traditional open-chest cardio-thoracic surgical procedure used to restore blood flow to the heart of people with severe coronary artery atherosclerosis. Before the advent of the the less invasive angioplasty and stenting, CABG was the main surgical approach to re-vascularization of a diseased heart. For certain combinations of coronary artery disease, and in some clinical settings, CABG remains the preferred approach today.

Why fewer invasive procedures?
In Kentucky, the frequency of both angioplasty and CABG have been gradually decreasing, presumably because the effectiveness of aggressive medical therapy is better recognized, and because research showed that the invasive approaches were being used in circumstances where they offered no advantage over non-invasive treatment. Treatment of coronary artery disease is lucrative for hospitals and physicians alike which unfortunately caused some to stretch the envelope beyond what could be justified medically, even to the point of fraud. That bubble is bursting and accounts for a some if not much of the overall decrease in invasive procedures.

Where will patients go?
The new plan in London is to transfer those patients requiring emergency surgery to one of the nearer hospitals capable of treating such a patient, presumably Pikeville, Hazard, Corbin, Asheville, Summerset, or Lexington. (Some of these hospitals perform fewer CABGs than in London!) For non-emergency surgery, patients will be referred to another KentuckyOne hospital– St. Joseph’s Lexington. Angioplasty and stenting will continue to be performed at St. Joseph’s London presumably with safeguards in place to make sure that the most appropriate procedure will be offered for medical reasons and not for convenience. Continue reading “St. Joseph’s London Discontinues Coronary Artery Bypass Surgery.”