Medicare to release billing data for 880K doctors

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http://news.yahoo.com/medicare-release-billing-data-880k-doctors-205234212--politics.html

Supporters of disclosure say the information will help lead consumers to doctors who have the greatest expertise and who get the best results. For example, if you're about to undergo heart bypass, you could find out how many operations your surgeon did 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 they would reasonably be expected to care for.

But doctors worry that some physicians could be unfairly singled out. They point to the example of clinicians practicing in economically depressed areas, seeing patients who can't afford medication copays or who don't follow through with basic self-care. The numbers may not look so good for those doctors, but it may not be because of anything they did wrong.

Officials say the files contain data on every test and procedure billed for in 2012 by individual doctors in all 50 states, who together received $77 billion that year through Medicare's Part B coverage for outpatient services. It will amount to close to 10 million lines of data. Doctors who saw fewer than 11 Medicare beneficiaries will be excluded.

Although individual patient information will remain off-limits, the files will identify physicians by name.
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Slimy move by Obama. He's playing all his cards. It's an attempt to make it look like docs are getting "rich" from Medicare. Yet most either not collecting a single cent from labs ordered because they either send them out or are already employees.
 
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Fraud and needless testing are part of the reason our system needed overhaul. I am completely in agreement with release of this info, as well as the info about the variable and seemingly random costs of hospitalization and procedures.
Taxpayers fund Medicare. Any conservative should be in favor of seeing how our money is spent/wasted. I couldn't be happier with the administration's demands for transparancy.
 
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aneftp said:
Slimy move by Obama. He's playing all his cards. It's an attempt to make it look like docs are getting "rich" from Medicare. Yet most either not collecting a single cent from labs ordered because they either send them out or are already employees.
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So can you, with a straight face, say you don't think there are a subset of doctors who just order every test and try every expensive med for off label use under the sun due to laziness/legal implications/kickbacks?

Sorry, I'm fresh out of gullible.
 
Pooh & Annie said:
Fraud and needless testing are part of the reason our system needed overhaul. I am completely in agreement with release of this info, as well as the info about the variable and seemingly random costs of hospitalization and procedures.
Taxpayers fund Medicare. Any conservative should be in favor of seeing how our money is spent/wasted. I couldn't be happier with the administration's demands for transperacy.
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Transparent in general or about this? Because the former... Lol
 
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MaximusD said:
So can you, with a straight face, say you don't think there are a subset of doctors who just order every test and try every expensive med for off label use under the sun due to laziness/legal implications/kickbacks?

Sorry, I'm fresh out of gullible.
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You don't get why they are releasing this data. The audience isn't working professionals like MDs, JDs, Ph.D's, MBAs.

Obama is releasing this data to appeal to the low income voters, lower educated people. Those are his voting base. He's building up a case to the "common person" who isn't as educated as we are but far outnumber us in terms of votes. He wants to show the raw data on medicare billing. Why?

Because the common person will just look at raw numbers and think all these docs are getting rich off medicare. Obama's voting base isn't educated enough to break down the raw data: some docs may work for companies. These companies may want the docs to see as many patients as possible and just happens they see many medicare patients. So on raw numbers it looks like this doc is making a million dollars off medicare. When in fact they may only get a slice of out and the rest of the money is going to pay for overhead PLUS profits from the company.

Do some docs abuse medicare billing? Absolutely. But they are few and far in between. In fact medicare fraud has decreased dramatically from 10% to under 3% in the past 15 years.
 
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Who's the audience again? You think low income voters are the type to review doctor's testing and billing data?
 
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What will the story be? Why do some doctors tend to test/bill far more than others for seemingly similar situations? That's a great question.

And what is the concern here? Someone will release a story that doctors get paid too much by fraudulently billing the system, leading to mass voting for politicians who campaign on "pay doctors less?" That's not the way it works. Also, "poor gullible voters" would probably already assume doctors make lots of money by over testing and over billing.

Once again, I'm very happy with the transparency.
 
Pooh & Annie said:
Who's the audience again? You think low income voters are the type to review doctor's testing and billing data?
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The media (especially left wing) MSNBC, NY Times, Wash Post, LA Times will "dumb" the raw data for their audience.

Because it will be too complicated for the common person. But the common person is the one that holds the same vote as a more educated person. And the common persons far out number the more educated person.

You really think if the Democratic administration would have sold the ACA to the public by saying that in order to insure more Americans, those middle to upper middle class will end up having to pay more for their healthcare. Absolutely not. They said the middle class would be protected. But little did the pubic know who really gets shafted.
 
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Pooh & Annie said:
Who's the audience again? You think low income voters are the type to review doctor's testing and billing data?
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The audience of this will be slimy journalists looking to publish a SENSATIONAL headline making doctors look like CONMEN.
 
Pooh & Annie said:
What will the story be? Why do some doctors tend to test/bill far more than others for seemingly similar situations? That's a great question.

And what is the concern here? Someone will release a story that doctors get paid too much by fraudulently billing the system, leading to mass voting for politicians who campaign on "pay doctors less?" That's not the way it works. Also, "poor gullible voters" would probably already assume doctors make lots of money by over testing and over billing.

Once again, I'm very happy with the transparency.
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There is absolutely no transparency the way this is done. Because the layman cannot understand

Unlike Canada where the govt is the only payer and no middle man involved (canada does publish physician payments to the public)

Posting Medicare payments doesn't tell the public much if anything at all. Come on. Do you really believe the administration when they say the public will know who's doing the most cases and therefor they assume is "competent" by billing Medicare more? Read the press release by the Administration. It's spin after spin.

How about Anesthesiologist working for GI center covering 3-4 rooms getting paid $300k. Yet gives up billing rights to AMC. The public doesn't know what an AMC is. They just still Dr GI anesthesia collecting 2 million in charges.

For any real transparency they must publish all insurance (including private) charges each doc makes plus publish whether third party company takes a cut of the profit whether it's AMC or hospital as W2 employee.
 
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Here's another list that, two of whom are in the top 10 who both make ****ty software systems that we doctors have to endure and struggle with and everyone hates. #1 McKesson and #6 Express Scripts. McKesson dude made $131 million in 2012.

http://www.forbes.com/lists/2012/12/ceo-compensation-12_land.html

Any practicing doctor make that much? Look at their 5 year payouts. Anyone make that much in the past 5 years?

I'm calling bull**** on these media stories and where they are getting their data especially the one about us making more than CEOs. Sure I probably make more of some "CEO" of some Mickey Mouse small company that employs 10 people. But I have peoples lives literally in my hands everyday. I'm not paid enough.
 
aneftp said:
You don't get why they are releasing this data. The audience isn't working professionals like MDs, JDs, Ph.D's, MBAs.

Obama is releasing this data to appeal to the low income voters, lower educated people. Those are his voting base. He's building up a case to the "common person" who isn't as educated as we are but far outnumber us in terms of votes. He wants to show the raw data on medicare billing. Why?

Because the common person will just look at raw numbers and think all these docs are getting rich off medicare. Obama's voting base isn't educated enough to break down the raw data: some docs may work for companies. These companies may want the docs to see as many patients as possible and just happens they see many medicare patients. So on raw numbers it looks like this doc is making a million dollars off medicare. When in fact they may only get a slice of out and the rest of the money is going to pay for overhead PLUS profits from the company.

Do some docs abuse medicare billing? Absolutely. But they are few and far in between. In fact medicare fraud has decreased dramatically from 10% to under 3% in the past 15 years.
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I agree.

The people reading this data aren't going to be people in the know. It's just going to be data that is covered by media to show the minority abusing the system.
 
This campaign against physicians will ultimately fail, but 15 years down the road. It will take bad outcomes by other providers and a HUGE shortage of physicians/surgeons for them to say....oops...we ****** up. After this, physician incomes will go back to acceptable levels. We need to winter the next decade at least. Hopefully this attitude of pitting the educated/hardworking folks vs. the opposite will end.
 
Here they come.... One guy supposedly was paid $20 million by Medicare, doesn't specify billed vs received etc (not that it matters at the $3 million level). Median was like $30k however. But I think we know the sensationalism that will be used to report these things.

http://m.huffpost.com/us/entry/5115393/

Edit: apparently my memory from reading article to posting is horrible. Corrected dollar amounts
 
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Per4mer8 said:
Here they come.... One guy supposedly was paid $3 million by Medicare, doesn't specify billed vs received etc (not that it matters at the $3 million level). Median was like $36k however. But I think we know the sensationalism that will be used to report these things.

http://m.huffpost.com/us/entry/5115393/
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Someone please sign on and respond to this nonsense.
 
I'm all for transparency, especially when it comes to the distribution of public funds.

But yes, the media is having a field day with this. One article I came across had the commenters calculating the hourly wage of some of the doctors with seven-figure Medicare reimbursement. The article itself seemed to imply that these figures were net personal compensation.
 
likeaboss said:
http://www.bloomberg.com/infographi...dical-specialties-cost-medicare-the-most.html

According to the above article anesthesiologists only get paid from Medicare $27k per year on average. Can anyone explain why this number is so low? Is it because so many gas docs are employees?
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As predicted, here begins the "dumbing down" of the data in what are sure to be dozens of articles in palatable chunks for the dummies of America. To answer your question, anesthesiology services have always been severely undervalued/paid.
 
Per4mer8 said:
Saw this today.... It will get no play, but I like it.

http://www.blog.greatzs.com/2014/04/doctors-should-get-kudos-for-accepting.html?m=1
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Trying to argue for or against reimbursement rates with actual reason is just a losing battle, since it's illogical to begin with. You're essentially artificially infusing a free market mechanism onto a market that is anything but. What is the REAL value of an emergent intubation? $99? $1000? $200,000? How do you know that? How would you prove it once you come up with a number? The value of an object or service is just what the consumer is willing to pay for it, but when the consumer is entirely shielded from the cost, how can there be any reasonable determination of its value?
 
The value is the amount most groups will do the procedure for. It's a matter of supply/demand. What's the value of an escort service?

If we do an emergency intubation for $99, that's exactly how much it's worth. We are (almost) all dumb ****s in medicine, that's a different story (nobody in their right mind would do that level of a procedure for that amount of money in a different line of work).
 
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FFP said:
The value is the amount most groups will do the procedure for. It's a matter of supply/demand. What's the value of an escort service?

If we do an emergency intubation for $99, that's exactly how much it's worth. We are (almost) all dumb ****s in medicine, that's a different story (nobody in their right mind would do that level of a procedure for that money in a different line of work).
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This. I heard from a radiologist I rotated with as a med student (so may not be true and I'm not downloading a million gig file to cross check) that reimbursement for a plain chest film read was $8. Now on one hand you can argue that a good radiologist can probably read and dictate 50-60 cxr's an hour for $400/hr+ and no one would complain about that kind of money. But on the other hand every single read comes with the assumption of what, $100k, $250k, a million dollars??? of risk/liability that is fairly permanent.

If you ask any stock guy, MBA, or Mark Cuban if they'd invest in or do business in an area with a profit margin of $8 per transaction in exchange for $100k of risk they'd laugh you out of the Shark Tank.
 
Per4mer8 said:
This. I heard from a radiologist I rotated with as a med student (so may not be true and I'm not downloading a million gig file to cross check) that reimbursement for a plain chest film read was $8. Now on one hand you can argue that a good radiologist can probably read and dictate 50-60 cxr's an hour for $400/hr+ and no one would complain about that kind of money. But on the other hand every single read comes with the assumption of what, $100k, $250k, a million dollars??? of risk/liability that is fairly permanent.

If you ask any stock guy, MBA, or Mark Cuban if they'd invest in or do business in an area with a profit margin of $8 per transaction in exchange for $100k of risk they'd laugh you out of the Shark Tank.
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Lol, wut? You can't calculate the risk without knowing the probability of the adverse event. $100k-250k isn't your risk - that's your expected loss. Your risk is the product of the probability and your expected loss. Then, you have to calculate your risk to reward ratio and determine if it's the right investment. I'm pretty certain in this scenario, it's worth it for the radiologist to read the film.
 
^ sure, obviously I made a simplified analogy and related worst possible financial outcome of a misread with each "investment".

Out of curiosity I used a quick google-fu to look into radiologist error rates: retrospective review finds ~30% error rates, "real time" error rates are quoted at 3-5% per day overall, when looking at studies with abnormalities this jumps to as high as 33%. Now of course, what percentage of errors lead to negative patient outcomes and litigation etc is another question.

Another example, for PNB's nerve injury is found to be somewhere between 1 in 3500 to 1 in 5000, if you collect $48 for 5000 ISBs before your first nerve injury you'd "clear" $240k. You sure your settlement will be less than that? Of course that settlement isn't out of pocket but still. (And again I realize there are other variables such as whether the nerve injury was permanent vs transient, did case lead to litigation etc.) But we are also over simplifying the scenario as if nerve injury is the only possible negative outcome.

My point remains, physicians perform a multitude of services or interventions with a much higher PERSONAL risk than other businesses/individuals for often meager reimbursement on a case by case basis. Which is fine, I guess. Not many of the new crop of med students or physicians went into medicine for the money, we do it for a combination of intellectual stimulation and desire to make a difference. But it just starts to get old being painted as greedy, fraudulent jerkoffs.
 
Per4mer8 said:
^ sure, obviously I made a simplified analogy and related worst possible financial outcome of a misread with each "investment".

Out of curiosity I used a quick google-fu to look into radiologist error rates: retrospective review finds ~30% error rates, "real time" error rates are quoted at 3-5% per day overall, when looking at studies with abnormalities this jumps to as high as 33%. Now of course, what percentage of errors lead to negative patient outcomes and litigation etc is another question.

Another example, for PNB's nerve injury is found to be somewhere between 1 in 3500 to 1 in 5000, if you collect $48 for 5000 ISBs before your first nerve injury you'd "clear" $240k. You sure your settlement will be less than that? Of course that settlement isn't out of pocket but still.
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Doesn't matter what the settlement is. It only matters what your malpractice premium is, if the settlement/loss is under the policy's cap, and whether or not someone will underwrite the policy.

If you do X number of procedures and collect $Y while paying $Z malpractice premiums, and aren't practicing so far out of standard (and aren't so unlucky) to get an unreasonable number of complications/settlements, where "unreasonable" is defined as "not so many that your malpractice carrier drops you" ... then the only thing that matters is whether or not you feel that $Y - $Z = a reasonable wage for the amount of time and effort it took you to do those X procedures.

The rest is just actuarial details for your carrier to get angsty about. And they're good at that sort of thing.


Your analogy only works in a world without any liability insurance available, and no way to spread risk. Then sure, no way I'd stick a needle in someone's neck for $48. But we're not living under the Code of Hammurabi:
If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money.
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Cool! Ten shekels spends nice!

If a physician make a large incision with the operating knife, and kill him, or open a tumor with the operating knife, and cut out the eye, his hands shall be cut off.
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Aw, ****.



Per4mer8 said:
My point remains, physicians perform a multitude of services or interventions with a much higher PERSONAL risk than other businesses/individuals for often meager reimbursement on a case by case basis. Which is fine, I guess. Not many of the new crop of med students or physicians went into medicine for the money, we do it for a combination of intellectual stimulation and desire to make a difference. But it just starts to get old being painted as greedy, fraudulent jerkoffs.
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I totally agree.
 
Per4mer8 said:
My point remains, physicians perform a multitude of services or interventions with a much higher PERSONAL risk than other businesses/individuals for often meager reimbursement on a case by case basis. Which is fine, I guess. Not many of the new crop of med students or physicians went into medicine for the money, we do it for a combination of intellectual stimulation and desire to make a difference. But it just starts to get old being painted as greedy, fraudulent jerkoffs.
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Sure, if you include 'personal' to mean non-financial. Obviously, the pain and stress a lawsuit would bring cannot really be measured in dollar amounts. But, it looks like you were talking about the dollar aspect with the comment about Mark Cuban and being laughed out of the shark tank. I would argue that you would be laughed out of the shark tank if you didn't partake in collecting that fee given the risk to reward ratio.
 
Consigliere said:
As predicted, here begins the "dumbing down" of the data in what are sure to be dozens of articles in palatable chunks for the dummies of America. To answer your question, anesthesiology services have always been severely undervalued/paid.
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Ok, so if the average anesthesiologist makes $350k and medicare only pays $27k of that. where does the other $323k come from?
 
In other news, I have no idea what motive the political force or entity has against physicians. Why does it matter that doctors make a decent living? Derms are evil because they have a good lifestyle and income! Why do people want docs to have less money and lifestyle?
 
wjs010 said:
In other news, I have no idea what motive the political force or entity has against physicians. Why does it matter that doctors make a decent living? Derms are evil because they have a good lifestyle and income! Why do people want docs to have less money and lifestyle?
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A couple of reasons:

1. We live in an everyone wants a ribbon culture.

2. People live in their own world and have no clue what kind of commitment it takes. Everyone thinks what they are doing is the best thing and should be paid more. When they see physician salary surveys they wonder why not me?? It breeds resentment.

3. We live in a time where the theme is economic equality....
 
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Per4mer8 said:
This. I heard from a radiologist I rotated with as a med student (so may not be true and I'm not downloading a million gig file to cross check) that reimbursement for a plain chest film read was $8. Now on one hand you can argue that a good radiologist can probably read and dictate 50-60 cxr's an hour for $400/hr+ and no one would complain about that kind of money. But on the other hand every single read comes with the assumption of what, $100k, $250k, a million dollars??? of risk/liability that is fairly permanent.

If you ask any stock guy, MBA, or Mark Cuban if they'd invest in or do business in an area with a profit margin of $8 per transaction in exchange for $100k of risk they'd laugh you out of the Shark Tank.
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This is true.
 
postbacpremed87 said:
A couple of reasons:

1. We live in an everyone wants a ribbon culture.

2. People live in their own world and have no clue what kind of commitment it takes. Everyone thinks what they are doing is the best thing and should be paid more. When they see physician salary surveys they wonder why not me?? It breeds resentment.

3. We live in a time where the theme is economic equality....
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Yup, the theme is class warfare front and center. Hence why Obama can say surgeons are charging $30,000 for amputations on diabetics and ENT docs are pulling out tonsils of little children. You can have your seat right next to the bankers as far as they are concerned.
 
DermViser said:
Yup, the theme is class warfare front and center. Hence why Obama can say surgeons are charging $30,000 for amputations on diabetics and ENT docs are pulling out tonsils of little children. You can have your seat right next to the bankers as far as they are concerned.
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What can we, as naive, green, and incoming students do to help protect our future? I feel like a lot of docs have balls of steel... The only reason they can't fight back is because they are too damn busy. Oh the irony. Fighting for your profession and defending your salary because people think you are a greedy, rich bastard, and NOT having the time to actually fight against it. Lol
 
wjs010 said:
What can we, as naive, green, and incoming students do to help protect our future? I feel like a lot of docs have balls of steel... The only reason they can't fight back is because they are too damn busy. Oh the irony. Fighting for your profession and defending your salary because people think you are a greedy, rich bastard, and NOT having the time to actually fight against it. Lol
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I would disagree. Most of the med students I've met so far are naive about real world practice and are generally pu$$ies. They'll let anyone stomp over them and not do anything about it.

I don't blame them though. Most students come into med school to "help people." It would cause significant cognitive dissonance to be aggressive and demanding.
 
Baller MD said:
I would disagree. Most of the med students I've met so far are naive about real world practice and are generally pu$$ies. They'll let anyone stomp over them and not do anything about it.

I don't blame them though. Most students come into med school to "help people." It would cause significant cognitive dissonance to be aggressive and demanding.
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I hate hearing "I want to help people". This is only a basic criteria for any service profession. Be a butler, a cab driver, a dry cleaner, a nanny, a lawyer, a nurse, etc, etc, et al, if you want to "help" people. Medicine and surgery is not for the weak. There are work and politics that demand you to be aggressive about standing your ground about your patient care, and in some cases even your existence.

If I ever sit on an ad com, I would be very unlikely to give the thumbs up on anyone who tells me they chose medicine because they want to "help people".

I used to be a clinical instructor in my former career and I've had to give this lecture. It's such a non-committal response.
 
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