Investigative health reporting lives: Milking Medicare

The latest in health data reporting  from ProPublica:

Medicare 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:

• Patient Safety 

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.

• The Prescribers:

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.

• Health industry dollars for doc

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

•  Omniscan

Specter of MRI Disease Haunts General Electric

• Brain Wars

How the Military Is Failing Its Wounded

• Dialysis

High Costs and Hidden Perils of a Treatment Guaranteed to All.  Nearly 40 years after Congress created a unique entitlement for patients with kidney failure, U.S. death rates and per-patient costs are among the world’s highest while the biggest for-profit providers flourish.

Berwick: More Dr. Death mongering

The Globe’s Susan Milligan reports today on the attempt by Republicans to tag Harvard professor Donald Berwick as a death merchant.  Berwick runs a research program that looks at ways to cut waste and improve health care services.  He is up for the job as head of The Center for Medicare and Medicaid Services, an agency that has the power to make major changes in the way health care is funded and delivered.   

… GOP’s senators are making it clear they plan to turn Berwick’s confirmation hearings into a forum for continuing debate over the newly-minted health care overhaul law. Republicans believe hammering at the law will help them win seats in the fall’s midterm elections.

Senate Republican leader Mitch McConnell of Kentucky said on the Senate floor last night that Berwick is an “expert on rationing.’’

By lauding the United Kingdom’s National Health System, McConnell said, Berwick “is applauding a system where care is delayed, denied, or rationed.’’

 At one time, only insurance companies and hosptials  balked at changes in the way we pay for care. The social conservatives stuck to abortion. Now, all that has changed. For more on that see the November 30 issue of The New Yorker  for a story on the Karen Ann Quinlan case — “The Politics of Death.”  Jill Lepore talks about how a hospital ethics panel had to decide whether the comatose women could ever recover. As she put it “These ethics committees are now better known as death panels.”

 The New Yorker has a pay wall so if you don’t have a subscriptions, it’s off to the library. You can read the abstract first.

 The Quinlan case marked a fundamental shift in American political history: in the decades since Quinlan, all manner of domestic-policy issues have been recast as matters of life and death—urgent, uncompromising, and absolute. Mentions Pope Paul VI’s “Of Human Life” and the Roe v. Wade decision in 1973. Two years later, the Quinlan case brought the end of life into the halls of government. In the wake of Roe and Quinlan, a very small but by no means inconsequential number of people have come to believe that Congress, the President, the courts, and assorted unnamed bureaucrats are plotting to deny medical care to the very sick and the very old, to babies born with deformities, to the elderly and infirm, to the ailing and the poor, to the disabled and insane. Most recently this conspiracy theory hijacked health-care reform.

 

 

Boston’s Berwick to run Medicare

AP is reporting that Obama will nominate Massachusetts pediatrician Donald Berwick — head of the  Institute for Healthcare Improvement Cambridge–to oversee Medicare and Medicaid.

The timing of the nomination is important because Berwick, if confirmed by the Senate, would take over an agency that has not had a permanent chief executive since Mark McClellan stepped down in the fall of 2006.

The Centers for Medicare and Medicaid Services runs the government health care programs for seniors and the poor, providing benefits to an estimated 100 million people — about 1 in 3 Americans.

Here’s a Q&A from Kaiser Health News.

Q: With health overhaul legislation moving forward, how are you feeling about major changes coming to our health system?

A: It’s a pretty exciting time. It’s time to commit to justice and that means universal coverage. We have got to go there. It’s embarrassing that we have not gone there. So that is job No. 1. But to do that simply by funding existing systems is a formula for a spiral we can’t endure. We have to restructure care and the system.

Can we do that from Capitol Hill and the White House? No. We can encourage it, we can support it, we can set some goals out at a price we can afford. But eventually this is going to devolve back to communities…only they can execute the changes and care structures that we really need. It could be an exciting time as we watch the mobilization of change at the level which change has to happen.

  Here’s a 2004 profile of Berwick from the Globe:

At this point, mild-mannered, soft-spoken, self-effacing 57-year-old Don Berwick can best be described as a revolutionary. A lot of people say the current health care system is broken, but by that they mean the manner of financing it. Berwick gets irritated when health care leaders complain about a lack of resources. There’s too much money in the system already, he says. His critique takes aim at the medical profession’s exalted view of itself. He’s convinced that the fundamentals of the current system — the same fundamentals Boston used to build its reputation as the world’s medical leader — are so screwed up that it is no longer possible for the medical profession to provide reliable, high-quality care, no matter how many innovations its renowned doctors roll out, no matter how many awards they rack up. “They want to cure cancer,” Berwick says. “Well, how about curing health care?”

His conclusion: To save the health care system, it first needs to be blown up.

 This from IHI:

We aim to improve the lives of patients, the health of communities, and the joy of the health care workforce by focusing on an ambitious set of goals adapted from the Institute of Medicine’s six improvement aims for the health care system: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity. We call this the “No Needless List”:

 No needless deaths
 No needless pain or suffering
 No helplessness in those served or serving
 No unwanted waiting
 No waste
 No one left outIHI works with health professionals throughout the world to accelerate the measurable and continual progress of health care systems toward these bold objectives, leading to breakthrough improvements that are truly meaningful in the lives of patients.