Former Tufts doc: “Widespread dishonesty” leads to unjustified health care fees #HCR

Former Tufts doc and current Mainer Howard A.Corwin comments this weekend on the latest in Elizabeth’s Rosenthal’s great NYTimes series on insane health care costs. In her latest piece, she reports that “In operating rooms and on hospital wards across the country, physicians and other health providers typically help one another in patient care. But in an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurers hefty fees.”

To which Corwin notes: 

To the Editor:

Doctors call such billing “gaming the system.” There is widespread dishonesty that leads to these unjustified expenses throughout the medical profession. Members of Congress beholden to medical lobbyists allow flawed reimbursement systems and perpetuate them by preventing reform. There is an enormous disparity between what different medical specialists and personnel earn. Unable to rectify these disparities, many physicians resort to these gaming techniques. Unnecessary expensive tests and procedures, upgraded coding, “scratch my back and I’ll scratch yours” referrals and, of course, outright greed lead to extra medical expense.

Honest doctors are demoralized and suffer from this system. Doctors must regain leadership of medicine to rectify these aberrant and destructive practices.

HOWARD A. CORWIN
Center Lovell, Me., Sept. 21, 2014

The writer is a former clinical professor of psychiatry at Tufts University School of Medicine.

#NEJM #Relman obit: “A master in the use of the bully pulpit” #HCR

A not entirely objective perspective on the  career of the journal’s storied editor. Here’s the last paragraph:

In the increasingly complex world of health care, Bud Relman was a prophetic figure, larger than life. He acted nejmas our conscience. In his writing and speaking, he always reminded us that the medical profession is far more than a business and that as physicians, we have the responsibility to do what is right for patients and for the community as a whole. As distinguished as he was as a researcher, clinician, editor, teacher, and administrator, Bud Relman will be most remembered for the way he fought for a fundamental reshaping of our nation’s health care system. His passionate commitment to that cause will forever secure his position in the pantheon of leaders in medicine.

 

 

Video: How to use national database to evaluate your doctor’s Medicare billing, treament patterns #hcr #doctors #costs

More from ProPublica:

Medicare recently released, for the first time, details on 2012 payments to individual doctors and other health professionals serving the 46 million seniors and disabled in its Part B program. Part B covers services as varied as office visits, ambulance mileage, lab tests, and the doctor’s fee for open-heart surgery. Use this tool to find and compare providers. | Related story »

Investigative health reporting lives: Milking Medicare

The latest in health data reporting  from ProPublica:

downloadMedicare paid for more than 200 million office visits for established patients in 2012. Overall, health professionals classified only 4 percent as complex enough to command the most expensive rates. But 1,800 providers billed at the top level at least 90 percent of the time, a ProPublica analysis found. Experts question whether the charges are legitimate.

For more: Top Billing: Meet the Docs who Charge Medicare Top Dollar for Office Visits

For a more precise look at your own doc note:

Looking at raw numbers, though, can unfairly flag some doctors who have multiple providers billing under their IDs or who justifiably use expensive services. It can be more revealing to look at which procedures doctors are performing and how frequently, and how their billings compare with those of their peers. (ProPublica has created a tool called Treatment Tracker that allows users to do just that.)

More health reporting from the ProPublica archives:

More than 1 million patients suffer harm each year while being treated in the U.S. health care system. Even more receive substandard care or costly overtreatment. Our ongoing investigation of patient safety features in-depth reporting, discussion and tools for patients.

Never-before-released government prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs known to be potentially harmful, disorienting or addictive for their patients. And officials have done little to detect or deter these hazardous prescribing patterns.

ProPublica is tracking the financial ties between doctors and medical companies.

Hospital closures: “Survival of the fattest”

No. Grove St. Today. Note street sign.

MGH

Some say the health care system could stand to shrink a bit. Here, Alan Sager of BU uses the sudden closure of North Adams Regional Hospital to argue that the wrong hospitals are closing.  Hidden on the Globe letters page:

Over half of the Massachusetts hospitals open when John F. Kennedy was elected president have now closed. Not one that closed was a major teaching hospital. Heavy reliance on teaching hospitals helps explain our state’s extraordinarily high hospital costs. The pattern of closings may be partly responsible for that reliance.

Some might suppose that a functioning free market protects needed and well-run hospitals while closing unneeded and inefficient ones. Sadly, that pattern seldom prevails. Low-cost, efficient hospitals are not likelier to survive. But hospitals in wealthier places, with more patients insured by higher-paying insurers, rarely close. Some call this survival of the fattest.

More good work from the Globe health desk here:

 Are cardiologists refusing to follow new cholesterol recommendations?

Good morning Denver: Health writers meeting this weekend #AHCJ14

ahcj-logo-topNot much of a Boston presence at the Association of Health Care Journalists meeting this weekend, but we take note anyway.

Even if you are not a writer, the meeting offers much clear-eyed insight into the health care system. And these days, tools we use to probe quality and costs are available to anyone who knows how to sort a spread sheet. Still, journalists and consumers alike need to know how to surf the ongoing tsunami of health care data.

So, follow #ahcj14 on Twitter for tips and the occasional link.

Globe, Times on some of the the 3 million newly insured

globe-ssWith the uproar about computer glitches with the new health insurance exchanges, you would never know that millions of people were about the get coverage at a reasonable cost.

Today, The Boston Globe’s  Chelsea Conaboy offers stories on five of them. The story is  behind the pay wall. You can look at the pictures, go out and buy the Sunday paper or get a digital subscription. 

Much has gone wrong since state and federal health insurance websites created under the Affordable Care Act launched on Oct. 1. Technological glitches have frustrated customers, flustered politicians, and fueled debate about President Obama’s landmark legislation.

Lost amid all the fury, however, have been the success stories.

Many who struggled without insurance are getting it. Others with poor coverage have found better plans. Some whose policies cost a lot, yet covered little, have obtained more comprehensive coverage that — with government subsidies — often costs less.

About 3 million people have signed up for a private health plan through the online insurance exchanges, a senior US health official said Friday. More people are newly enrolled in Medicaid in states expanding that program, which provides coverage to people with low incomes.

Or, check out this story from last week’s New York Times about how the law is having an immediate impact on people who suddenly qualify for Medicaid.

WELCH, W.Va. — Sharon Mills, a disabled nurse, long depended on other people’s kindness to manage her diabetes. She scrounged free samples from doctors’ offices, signed up for drug company discounts and asked for money from her parents and friends. Her church often helped, but last month used its charitable funds to help repair other members’ furnaces.

Ms. Mills, 54, who suffered renal failure last year after having irregular access to medication, said her dependence on others left her feeling helpless and depressed. “I got to the point when I decided I just didn’t want to be here anymore,” she said.

So when a blue slip of paper arrived in the mail this month with a new Medicaid number on it — part of the expanded coverage offered under the Affordable Care Act — Ms. Mills said she felt as if she could breathe again for the first time in years. “The heavy thing that was pressing on me is gone,” she said.

 

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