KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

First Edition: April 10, 2014

Today's headlines include a range of stories taking additional looks at the Medicare physician payment data released yesterday by the Centers for Medicare & Medicaid Services.

Kaiser Health News: Medicare Records Provide Tantalizing New Details Of Payments To Doctors
Kaiser Health News staff writer Jordan Rau reports: “Medicare’s release Wednesday of millions of records of payments made to the nation’s doctors comes as the government is looking to find more cost-efficient ways to pay physicians, particularly specialists” (Rau, 4/9). Read the story.

Kaiser Health News: Doctors' Billing System Stays Stuck In The 1970s For Now
Eric Whitney, reporting for Kaiser Health News in collaboration with NPR, reports: “For doctors, hospitals and insurance companies, all the complexities of medicine get boiled down into a system of codes. These codes are used to track and pay for every procedure – like an 813.02 for mending a broken forearm, or an 800.09 for treating a concussion. But this coding system is now four decades old, and it doesn't meet the needs of the medical system today. It was scheduled to be upgraded this October, but Congress delayed it last week. JaeLynn Williams, for one, is seriously bummed out” (Whitney, 4/10). Read the story.

Kaiser Health News: Barriers Remain Despite Health Law's Push To Expand Access To Substance Abuse Treatment
Kaiser Health News staff writer Anna Gorman, working in collaboration with USA Today, reports: “The nation’s health law has promised sweeping changes to help millions of people with drug or alcohol addiction get treatment. Many unable to afford services in the past now can receive them without first landing in jail or an emergency room, health officials say” (Gorman, 4/10). Read the story.

Kaiser Health News: Capsules: Alzheimer’s Disease Support Model Could Save Minn. Millions
Kaiser Health News staff writer Lisa Gillespie reports: “As states eye strategies to control the costs of caring for Alzheimer’s patients, a New York model is drawing interest, and findings from a study of Minnesota’s effort to replicate it shows it could lead to significant savings and improved services” (Gillespie, 4/10). Check out what else is on the blog.

The New York Times: The Medicare Data’s Pitfalls
The release on Wednesday of Medicare payment data is getting mixed reviews from doctors. Many say they favor sharing information but worry that the data presented by Medicare omits important details and may mislead the public and paint an unfairly negative picture of individual doctors (Grady and Fink, 4/9).

The Wall Street Journal: Doctor-Pay Trove Shows Limits Of Medicare Billing Data
The trove of Medicare data released Wednesday shows a wide cast of characters in the top ranks of the highest-reimbursed doctors, and reveals as much about the limits of the newly public billing records as it does about medical practice (Weaver, Beck and Winslow, 4/9).

The Washington Post: Cost Of Drugs Used By Medicare Doctors Can Vary Greatly By Region, Analysis Finds
An analysis of government data released Wednesday shows that the cost of drugs administered by doctors accounts for a growing piece of Medicare’s spending and varies widely from region to region in the United States, raising questions about whether some physicians may be misusing the pharmaceuticals. Most of the 4,000 doctors who received at least $1 million from Medicare in 2012 billed mainly for giving patients injections, infusions and other drug treatments, those records show (Whoriskey, Keating and Sun, 4/9).

The New York Times: Political Ties Of Top Billers For Medicare
Two Florida doctors who received the nation’s highest Medicare reimbursements in 2012 are both major contributors to Democratic Party causes, and they have turned to the political system in recent years to defend themselves against suspicions that they may have submitted fraudulent or excessive charges to the federal government (Robles and Lipton, 4/9).

Los Angeles Times: Medicare Pay Data Shock And Anger Many Doctors Listed As High Earners
Like dozens of other doctors across the country, Nguyen was unwittingly thrust into the spotlight as federal officials listed for the first time what the government pays individual doctors to treat elderly Americans. Some of those with the highest billings had already drawn public scrutiny as part of government investigations into healthcare fraud. But many more doctors were shocked to see where they ranked, since Medicare hadn't shared the data with physicians before publication (Terhune and Smith, 4/9).

The Wall Street Journal: Medicare Payment Data Throw Spotlight On Potential Abuses
Some doctors who received large sums from Medicare in 2012 have had run-ins with the law, signaling how the government's unprecedented move to make such payments public could throw up red flags for potential abuse. The physician paid the most by Medicare in 2012 is a high-profile south Florida ophthalmologist who has been fighting with the federal government for years over allegations of overbilling (Mathews, Carreyrou and Barry, 4/9).

The Washington Post: Doctors React To Release Of Medicare Billing Records
Doctors reacted swiftly and indignantly to Wednesday’s release of government records revealing unprecedented details about Medicare payments to physicians. Many resented being included on a list that showed some doctors billing Medicare for millions of dollars. The top 10 doctors alone received a combined $121.4 million for Medicare Part B payments in 2012 (Millman and Fallis, 4/9).

The New York Times: Eye Doctors Say Their Profits Are Smaller Than Data Makes Them Look
Although consumers and health experts will be poring over the newly released Medicare data for months, maybe years to come, one startling piece of information has already emerged, demonstrating some of the complexity inherent in the long-fought-over information on 880,000 health care providers across the country (Pollack and Abelson, 4/9).

The Wall Street Journal: Medicare Paid One Doctor More Than $20 Million In 2012
The doctor who was paid the most by Medicare in 2012 is a high-profile south Florida ophthalmologist who has been fighting with the federal government for years over allegations of overbilling. Salomon Melgen, whose practice was searched twice last year by the Federal Bureau of Investigation, got $20,827,340.74 from the Medicare program in 2012. With four offices and 30 employees, Dr. Melgen draws almost 70% of his patients from the program, according to court documents, and often performs injections of medications to treat macular degeneration, a condition that can cause blindness (Mathews and Schwartz, 4/9).

The Washington Post’s Wonkblog: Want To See How Problematic Medicare Pricing Is? Look To Ophthamology
One particularly striking example in the new data: billing in ophthalmology. The data show that there were nearly 4,000 individual physicians who each billed Medicare for at least $1 million in 2012 alone. As The New York Times noted, ophthalmology was the specialty that billed the highest total (Ehrenfreund, 4/9).

The Associated Press: Top-Paid Medicare Doctors Say They Have Reasons
How is it that a few doctors take in millions of dollars from Medicare? Explanations for Wednesday’s eye-popping numbers from Medicare’s massive claims database ranged from straightforward to what the government considers suspicious, as the medical world confronted a new era of scrutiny (4/9).

USA Today: Poll: Health Law’s Campaign Clout Bad News For Democrats
The Affordable Care Act looms as a powerful issue in this year's congressional elections, a USA TODAY/Pew Research Center Poll finds, and one that is reverberating in ways likely to boost the GOP. In the survey, taken after President Obama announced a surprising 7.1 million Americans had signed up for health care through the law's exchanges, more than eight in 10 registered voters say a candidate's stance on the law will be an important factor in determining their vote. A 54% majority call it very important (Page, 4/10).

The New York Times: Health Goal Met, White House Reviews Missteps
In an hourlong interview they requested, the officials said one of their biggest mistakes in the disastrous health care rollout last fall was worrying about the wrong thing. They said they focused too much on their ultimately unfounded fear that not enough insurance companies would participate in the health marketplaces and that premium prices would be too high. In turn, they said, they ignored what became the real problem, a website that was virtually inaccessible in its opening days (Shear, 4/9).

The Washington Post’s The Fact Checker: Did Obama Warn About … Obamacare?
Of course, McCain did not become president. And Obama, who has argued against adopting an individual mandate, as proposed by Hillary Clinton, ended up embracing exactly that option—and even accepted a variation of an idea from McCain that he criticizes in this ad. Politicians change their minds—and their policies—all the time, sometimes for political reasons but also because circumstances change. But within the benefit of hindsight, could McCain have made the same attack ad against Obama? The Truth Teller Video above also examines the claims (Kessler, 4/10).

The Associated Press: Senate Hopeful Brown: Health Law Costs Liberty
Hoping to return to Washington by way of New Hampshire, former Massachusetts Sen. Scott Brown is using a variation of the state’s “Live Free or Die” motto to argue against President Barack Obama’s health care overhaul law. Brown planned to formally announce his Senate bid Thursday night. In excerpts of remarks provided by his campaign, he said the health care law forces people to “live free or log on” (4/10).

Politico: House Rejects Expatriate Obamacare Bill
The House on Wednesday rejected a bipartisan bill that would have changed how expatriates and their insurance carriers comply with Obamacare, amid strong opposition from senior Democrats who said it created large loopholes in the health law. The bill, H.R. 4414, fell 257-159. Republican leaders brought the bill to the floor under suspension of the rules, a procedure that requires support from two-thirds of members voting. It’s usually used for noncontroversial legislation, but opposition to this bill mounted all day, leading to its surprise defeat (Haberkorn, 4/9).

The Associated Press: Lt. Gov To Lead Va. Mental Health Task Force
Lt. Gov. Ralph Northam will lead a state task force on mental health. Gov. Terry McAuliffe signed an executive order Wednesday extending a task force first created by former Gov. Bob McDonnell last year following the suicide of a state senator’s son (4/9).

The Associated Press: NY Health Commissioner Steps Down For Calif. Job
New York Health Commissioner Dr. Nirav Shah will step down in June to take an executive position with Kaiser Foundation Health Plan in California, the health department said Wednesday. During Shah's tenure as state health commissioner, he became a lightning rod for critics of hydraulic fracturing for natural gas because of the Cuomo administration's plan for an extended review of the technology. The health department also established a state health insurance exchange under the federal Affordable Care Act (4/9).

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