Category: Medicare

Financial Status a Barrier to Organ Transplantation But Not Donation.

It is easier to give than to receive in the transplant world.

organ donationIn a comment added to a recent article about the current financial status of Catholic Health Initiatives (the parent company of KentuckyOne Health) it was alleged that Jewish Hospital in Louisville did not accept Medicaid patients for organ transplantation. Because of the seriousness of this allegation, I was reluctant to allow it to stand without further comment. I therefore did some research and elicited comments from involved parties. The results trouble me and highlight yet another major example of the disparity of access to health care in our inherently unfair non-system, dividing Americans as it does by socio-economic status. In the case of transplantation, the operational result is particularly ugly, because the weight of government regulation and community has given us a morally indefensible result analogous to the rich stealing organs from the poor. I call this an example of the “Reverse Robin Hood” nature of America’s National Health System! Neither Jewish Hospital nor UofL are responsible for this situation, but have benefited from it. Continue reading “Financial Status a Barrier to Organ Transplantation But Not Donation.”

Medicare Payments to Oncologists in Kentucky.

Since my initial exploration of Medicare’s Physician Payment Database, I have not done much with it. The expectation that the information would be of great interest to many has been validated, and the utility and shortcomings of the data better understood. The potential is great that these data can be used to improve the quality, affordability, and availability of medical care. As might have been predicted however, a great deal of attention has been focused on identifying medical malfeasance and fraud.

I have always been of the opinion that examination of outliers in big data sets like this one is extremely valuable in health policy research. This is especially true in American medicine where there is such great variation both in the frequency in which various medical services are provided, and the amount of money charged. Looking at outliers does not automatically assume that something inappropriate is going on. A place or provider where a large number of things are being done may be a center of recognized excellence. On the other hand, and as we have seen in this series of articles, such “hotspots” of activity may represent inappropriate, abusive, or even illegal medical practice. I believe that large utilization data sets like this one beg us to ask questions about how to use our healthcare resources fairly, efficiently, and most of all effectively. A strategy I recommend is to start by looking more closely at the top 10 and the bottom 10 on any such list. Is that entry there for the best of reasons to be emulated, or for reasons of less value to be corrected? When you are done with the top ten, go on to the next, and so on. Continue reading “Medicare Payments to Oncologists in Kentucky.”

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.”

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!”