Category: Physicians

Doctors Push Back on Release of Data

doctor-xray-2Doctors reacted swiftly and indignantly to Wednesday’s release of government records revealing unprecedented details about Medicare payments to physicians…The top 10 doctors alone received a combined $121.4 million for Medicare Part B payments in 2012…In interviews, many of the doctors said they were just passing through the payment to drug companies. Some said they were unfairly singled out even though they were billing for an entire practice. And still others disputed the accuracy of Medicare data. (Washington Post)

What Happens After Surgeons Take a Break?

We find that a surgeon’s additional day away from the operating room raised patients’ inpatient mortality risk by up to 0.067 percentage points (2.4% relative effect) but reduced total hospitalization costs by up to 0.59 percentage points…Our findings are consistent with the hypothesis that after returning from temporal breaks surgeons may be less likely to recognize and address life-threatening complications, in turn reducing resource use. (NBER Working Paper)

How We Handle Bad Doctors

Adoctor-bribe-convicted colleague called [Christopher Duntsch] a sociopath and a “clear and present danger” to patients.  Another doctor compared him to a serial killer…

While at Baylor Plano, Duntsch was accused of maiming several patients and causing the death of another. One patient — his roommate and closest friend — claimed that Duntsch operated on him after a night of using cocaine, which Duntsch denied. The roommate emerged from the surgery a quadriplegic.

Yet when Duntsch departed Baylor Plano in 2012, the hospital stated that his record was officially clean. (Dallas Morning News)

Update on Doctor Pay Fix

  • CBO says a fix will cost $153 billion over the next ten years.
  • Rs and Ds have agreed on a fix, but they haven’t found a way to pay for it.
  • But if they don’t do something doctors are about to get a double digit pay cut under Medicare.
  • Under the deal, 9% of doctor fees will be based on conformance to quality indicators by 2021. But since we know that P4P doesn’t work, it’s not clear why they are going through the motions.

The plan. Sarah Kliff commentary.

Are Doctors Ready for 68,000 Diagnostic Codes?

Know someone who drowned from jumping off burning water skis? Well, there’s a new medical billing code for that.

icd10picture-resized-600Been injured in a spacecraft? There’s a new code for that, too.

Roughed up by an Orca whale? It’s on the list.

There are codes for injuries incurred in opera houses and while knitting, and one for sibling rivalry.

Next fall, a transformation is coming to the arcane world of medical billing. Overnight, virtually the entire health care system — Medicare, Medicaid, private insurers, hospitals, doctors and various middlemen — will switch to a new set of computerized codes used for determining what ailments patients have and how much they and their insurers should pay for a specific treatment.

I.C.D.-10, with codes containing up to seven digits or letters, will have about 68,000 for diagnoses and 87,000 for procedures.

Andrew Pollack at the NYT.

Would the “Doc Fix” Allow the Feds to Tell Doctors How to Practice Medicine?

This database would eventually be used to identify “outlier ordering professionals.” These are doctors who show a “low adherence” to the “appropriate use criteria.” Starting in 2020, these “outlying” doctors would then be required to seek the advance permission of the government through a “prior authorization” process administered by a government website before they can order services for their patients.

docfixAll of these provisions are written to pertain to imaging services and radiologists. But language included at the end of this section of the legislation gives the HHS secretary broad discretion to establish an “appropriate use program for other Part B services.”

This includes everything doctors do outside the hospital. The legislation allows Medicare to apply the same regulatory framework to other medical specialties like oncology.

These provisions are part of a much broader, secular shift toward increasing control of the practice of medicine by the federal government. With “applicable appropriate use criteria,” Washington would have the tool to effectively control the practice of medicine for America’s senior citizens.

Scott Gottlieb in the WSJ.

Exchange Plans Paying Less Than Medicare?

brave-declining-reimbursement-ratesThe benchmark for physician fees is the rate the federal government sets for services provided to older Americans through Medicare. In many markets, commercial plans may pay slightly above the Medicare rates, while doctors say that many of the new exchange plans are offering rates below that.

Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. But information cobbled together from interviews suggests that if the Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70. Doctors say the insurers have not always clearly spelled out the proposed rate reductions.

Source: Kaiser Health News.

Can We Pay for Value, Not Quantity?

Paying physicians:

By 20Kolb17, physicians will be rewarded or penalized on the basis of the relative calculated value of the care they provide to Medicare beneficiaries.

But is this a good idea?

…[T]he practical reality is that the Centers for Medicare and Medicaid Services (CMS), despite heroic efforts, cannot accurately measure any physician’s overall value, now or in the foreseeable future. Instead of helping to establish a central role for performance measurement in holding providers more accountable for the care they provide and in informing quality- and safety-improvement projects, this policy overreach could undermine the quest for higher-value health care.

Why Don’t Doctors Take Sick Days?

A survey of British doctors back in the ’90s found that 87 percent of G.P.’s said they would not call in sick for a severe cold (compared to 32 percent of office workers who were asked the same question). In Norway, a 2001 survey revealed that 80 percent of doctors had reported to work while sick with illnesses for which they would have advised their own patients to stay home. Two-thirds of these illnesses were considered contagious. (NYT)

“If You Like Your Doctor, You Can Keep Your Doctor”

Many new health exchanges don’t yet let shoppers see which doctors accept which insurance plans. Where exchanges do post the so-called provider lists, they often contain inaccurate or misleading information, some doctors say, including wrong specialties, addresses and language skills, and no indication whether providers are accepting new patients. (Wall Street Journal)