Medicare payments to individual physicians now available for all to see

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Tamahawk

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Again, the NYT brings more public scrutiny upon doctors. Anyone can look up a physician by name to see their Medicare billing (in 2012). On the upside, shady providers may get more heat. On the downside, these data are misleading in many ways...

http://www.nytimes.com/interactive/2014/04/09/health/medicare-doctor-database.html

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Again, the NYT brings more public scrutiny upon doctors. Anyone can look up a physician by name to see their Medicare billing (in 2012). On the upside, shady providers may get more heat. On the downside, these data are misleading in many ways...

http://www.nytimes.com/interactive/2014/04/09/health/medicare-doctor-database.html

And to think I thought the New York Times was done with beating up on Mohs Surgeons, at least for now. Ridiculous, bc nearly all of Mohs medical services are procedural in nature. Wouldn't surprise me if some, esp. in large cities, started cutting back on Medicare patients to keep from being demonized for being an outlier.
 
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so basically, doctors are evil because they make good money instead of working for free?
 
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And to think I thought the New York Times was done with beating up on Mohs Surgeons, at least for now. Ridiculous, bc nearly all of Mohs medical services are procedural in nature. Wouldn't surprise me if some, esp. in large cities, started cutting back on Medicare patients to keep from being demonized for being an outlier.


The top 5 dermatologists in my state are all general dermatologists who do their own pathology and Mohs; my fellowship trained colleagues and myself, all as busy as we can possibly be, each collect between 1/4 and 1/2 of the amount these top 5 do.

Shine that light -- we already knew who the ones who would need to scurry off to the shadows were.
 
"Doctors save lives everyday... And improve quality of life.Let's make sure we make them feel very guilty about their "riches"... Because it didn't take any work or debt to get where they are"- avg person
 
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The top 5 dermatologists in my state are all general dermatologists who do their own pathology and Mohs; my fellowship trained colleagues and myself, all as busy as we can possibly be, each collect between 1/4 and 1/2 of the amount these top 5 do.

Shine that light -- we already knew who the ones who would need to scurry off to the shadows were.

That is kind of disturbing. Why/how are they able to bill so much more? I don't really have much billing experience, being a resident.
 
The top 5 dermatologists in my state are all general dermatologists who do their own pathology and Mohs; my fellowship trained colleagues and myself, all as busy as we can possibly be, each collect between 1/4 and 1/2 of the amount these top 5 do.

Shine that light -- we already knew who the ones who would need to scurry off to the shadows were.

How are they able to practice Mohs without being specialty trained?
 
You don't have to be fellowship trained to practice Mohs or read slides (happens frequently in California)

I'm just surprised that one would perform Mohs without being fellowship trained. Very risky from a malpractice standpoint.
 
There are more society guys than college guys at this point, I believe. I'm avoiding the political turf war. ;)

I believe you are correct.

I've seen both points of view. Know of plenty of college guys who sneer at the society guys. Also know a couple of college guys who feel the society guys are a necessary evil in terms of providing a voice for Mohs (power in numbers theory)
 
That is kind of disturbing. Why/how are they able to bill so much more? I don't really have much billing experience, being a resident.

Mostly on biopsies and path volume ---> performing Mohs on any little thing. Medicare does not give two ****s if you are resecting a multiply recurrent SCC with perineural tracking on the lower lip or eyelid vs the barely existent BCC / SCCi "with microinvasion" on the middle of the cheek as far as payment is concerned.
 
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Mostly on biopsies and path volume ---> performing Mohs on any little thing. Medicare does not give two ****s if you are resecting a multiply recurrent SCC with perineural tracking on the lower lip or eyelid vs the barely existent BCC / SCCi "with microinvasion" on the middle of the cheek as far as payment is concerned.
Is there like a panel on CMS who decides what is and is not important ? Is it a bunch of physicians? Please tell me it's not only politicians .
 
Mostly on biopsies and path volume ---> performing Mohs on any little thing. Medicare does not give two ****s if you are resecting a multiply recurrent SCC with perineural tracking on the lower lip or eyelid vs the barely existent BCC / SCCi "with microinvasion" on the middle of the cheek as far as payment is concerned.

I fully expect this to change sometime in the not so distant future.
 
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Mostly on biopsies and path volume ---> performing Mohs on any little thing. Medicare does not give two ****s if you are resecting a multiply recurrent SCC with perineural tracking on the lower lip or eyelid vs the barely existent BCC / SCCi "with microinvasion" on the middle of the cheek as far as payment is concerned.
After the NY Times article, I expect this to change (even though we have no idea about the specific medical details of that Mohs case).Probably more scrutinized peer review or more scrutiny in auditing by insurance companies.
 
Mostly on biopsies and path volume ---> performing Mohs on any little thing. Medicare does not give two ****s if you are resecting a multiply recurrent SCC with perineural tracking on the lower lip or eyelid vs the barely existent BCC / SCCi "with microinvasion" on the middle of the cheek as far as payment is concerned.

I thought this must be one of the reasons. Nothing like mohsing that invisible SCCis...

I attended the Mohs controversy debate/presentation at the AAD where they talked about the fellowship vs non-fellowship issue. I think the majority of audience members raised their hands when asked who was NOT fellowship trained but did Mohs. Most of these were definitely older docs.
 
I thought this must be one of the reasons. Nothing like mohsing that invisible SCCis...

I attended the Mohs controversy debate/presentation at the AAD where they talked about the fellowship vs non-fellowship issue. I think the majority of audience members raised their hands when asked who was NOT fellowship trained but did Mohs. Most of these were definitely older docs.

The same ones who don't have participate in MOC and get lifetime certification, go figure.
 
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There are a few younger folks that practice mohs but not officially fellowship trained. Actually, they have done a pretty nice job with their repairs (in California as was mentioned earlier). They don't get referrals like Mohs_01 but they do it for their own patients. Some of them are not bad apples at all and do a very nice job. That said, I think we need to know our limitations and some of us don't seem to know (while others do a fine job of knowing).
 
There are a few younger folks that practice mohs but not officially fellowship trained. Actually, they have done a pretty nice job with their repairs (in California as was mentioned earlier). They don't get referrals like Mohs_01 but they do it for their own patients. Some of them are not bad apples at all and do a very nice job. That said, I think we need to know our limitations and some of us don't seem to know (while others do a fine job of knowing).

What is "not officially fellowship trained" supposed to mean? Sounds like a really weird way to say untrained (or inadequately trained).

I really wouldn't mind these untrained folks who cherry pick the easy cases, if they approached it the right way. That seldom happens.

What normally happens (and this is what I would consider to be the wrong way) is that the doc represents themselves as an expert in Mohs surgery and then does the procedure. Most of the time things are fine, but sometimes unexpected stuff happens, and then things go one of two ways:

-The doc just tries to do it anyway, even though it is beyond what they ought to be doing (worst option)
-Pt refers to a trained Mohs surgeon to bail them out (less bad, but still not as good as if they had just referred in the first place).

So, what is the best way? If the dermatologist just told the pt, "Look this is something that I think I can take care of for you very well, but there is another specialist I could refer you to who has more training and experience in the procedure. What would you prefer to do?", and then let the patient decide, I think that would be fine (and many pts would probably just choose to stay with the doc they already have a relationship with). However, in my experience, this is seldom done.
 
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After the NY Times article, I expect this to change (even though we have no idea about the specific medical details of that Mohs case).Probably more scrutinized peer review or more scrutiny in auditing by insurance companies.

It would be funny if that were the reason, because even based on the limited details that were provided in the article, that case was definitely a legitimate Mohs case. Maybe not the hardest case, but certainly an appropriate use of Mohs.
 
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It would be funny if that were the reason, because even based on the limited details that were provided in the article, that case was definitely a legitimate Mohs case. Maybe not the hardest case, but certainly an appropriate use of Mohs.
I agree, it was definitely a legitimate Mohs case, ironically enough.
 
Very unfortunate about these Medicare payments being made public. Perhaps other physicians will realize how well Mohs pays and start to pick it up themselves. Plastic surgeons and such could probably take some of the business. I think it should be required to do a fellowship for Mohs, but apparently that's not the case always.
 
Very unfortunate about these Medicare payments being made public. Perhaps other physicians will realize how well Mohs pays and start to pick it up themselves. Plastic surgeons and such could probably take some of the business. I think it should be required to do a fellowship for Mohs, but apparently that's not the case always.

Because plastic surgeons have such a great foundation of dermpath during their surgical residency? Seriously, stop trolling.
 
Because plastic surgeons have such a great foundation of dermpath during their surgical residency? Seriously, stop trolling.

I was referring to the close professional relationship between derm and plastics.
 
Very unfortunate about these Medicare payments being made public. Perhaps other physicians will realize how well Mohs pays and start to pick it up themselves. Plastic surgeons and such could probably take some of the business. I think it should be required to do a fellowship for Mohs, but apparently that's not the case always.
0 out of 10 for that trolling performance.
 
Ok reno, now this is the definition of a straw man argument (believe it was in another thread). Not worth a response beyond this.
 
Very unfortunate about these Medicare payments being made public. Perhaps other physicians will realize how well Mohs pays and start to pick it up themselves. Plastic surgeons and such could probably take some of the business. I think it should be required to do a fellowship for Mohs, but apparently that's not the case always.
That is what you came away with from that data?

lmao@clown
 
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That is what you came away with from that data?

lmao@clown
You should see some of his other hilarious posts, before his account got put on hold. It's like he wasn't even trying to hide his trolling.
 
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