The prices that hospitals ask customers to pay for a series of common procedures have increased by more than 10 percent between 2011 and 2013 — more than double the rate of inflation.þþBut the amounts paid by Medicare, the government health care program for seniors and the disabled, has stayed flat, according to data released Monday by the federal government. The hospitals’ rising list prices mainly affect the uninsured and people who use hospitals outside their insurance network.þþThe information about charges and payments was part of a large release of data, representing about $62 billion in Medicare payments and more than seven million hospital discharges. The data release also included information about roughly 950,000 doctors and health care practitioners who received $90 billion in Medicare payments. Cancer and eye doctors again topped the list of high earners.þþThe list of doctors receiving the highest reimbursements in 2013 included two familiar names from a year earlier, both of whom are facing legal action for their billing practices.þþThe second-highest earner in 2013 was Dr. Asad Qamar, a Florida cardiologist who received $16 million in 2013, according to an analysis by The New York Times. In January The Times reported that he is being sued by the federal government as part of two whistle-blower lawsuits that claim he performed unnecessary surgeries.þþGreg Kehoe, a lawyer for Dr. Qamar, said that his client had a large medical practice with other doctors and that he provided excellent care.þþThe third-highest biller was Dr. Salomon Melgen, a Florida ophthalmologist who has been indicted on Medicare fraud charges and on claims that he traded gifts and trips for political favors from Senator Robert Menendez, a New Jersey Democrat who was himself indicted on corruption charges this year. Dr. Melgen received $14.4 million from Medicare in 2013.þþ“Dr. Melgen stands by his record of improving the vision and quality of life of patients from around the world,” said Kirk Ogrosky, a lawyer for Dr. Melgen and partner at Arnold & Porter in Washington, who emphasized that the majority of the amount Dr. Melgen received represented the cost of drugs. “Regarding the pending cases, Dr. Melgen is not guilty of the charges that have been leveled against him, and we will speak about the cases through through our filings in court.”þþThe doctor who received the most from Medicare was Dr. Anne Greist, a co-founder of the Indiana Hemophilia & Thrombosis Center. She received $28 million in payments, but nearly all of that — $27.9 million — was for reimbursements for drugs. Dr. Greist could not be reached for comment; the center’s executive director, Nancy Hoard, said that she was the lead patient coordinator and the center’s most frequent prescriber. In addition, Ms. Hoard said the center was the only hemophilia treatment center in Indiana and treated a number of patients who required very expensive drugs.þþMedicare’s now-annual release of the data has been helpful for academics, journalists and private companies trying to understand how the health care system works. It is the third time Medicare has released such information about hospitals, and the second time it has done so for physicians.þþAdvertisementþþContinue reading the main storyþAdvertisementþþContinue reading the main storyþAdvertisementþþContinue reading the main storyþThe overall trends shown in the data released this week did not differ substantially from that of previous years, but, taken together, they provide a useful glimpse into the health care system through the Medicare program.þþDr. Bob Kocher, a partner at the venture capital firm Venrock and a former Obama administration health care policy official, said the data was already spurring entrepreneurship in health analytics, helping to create consumer tools, rooting out fraud and enabling new research. “It’s going to be used in thousands of ways that you wouldn’t have thought of,” he said.þþMost people with health insurance, including those receiving Medicare, won’t ever a see a bill for the hospital’s list price because the insurer negotiates a lower rate. But these rising charges are a growing concern for some consumers, especially those who are uninsured or seek care in a hospital that is not in their insurer’s network.þþThe last few years have seen an increase in the number of health insurers offering plans with limited networks of doctors and hospitals, meaning that it may be easier than ever for a patient to choose the wrong hospital and face a big bill.þþContinue reading the main storyþþInteractive Graphic: How Much Hospitals Charged Medicare for the Same Types of Casesþ“As networks narrow, charges for out-of-network providers become more important,” said Caroline F. Pearson, a senior vice president at Avalere Health, an industry consulting firm.þþThe list prices are not just growing, but are substantially higher than what Medicare pays. In the case of joint replacement, the most common reason for hospitalization in the data, the average hospital charged around $54,000 in 2013. Medicare, on average, paid around $12,000.þþIncreasing the list price is a simple way for hospitals to increase revenues, said Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins Bloomberg School of Public Health. “They want to get more money, and the only way they can do this is to raise their prices,” he said. Even if hospitals don’t get the full amount they are charging customers, he said, raising the list price “gets them some cents on the dollar.”þþThe American Hospital Association asserts that the rising prices reflect the costs of running a hospital. “Over all, health care costs tend to rise higher than inflation rates,” said Caroline Steinberg, a vice president of the association. She added that Medicare, which sets its own prices, pays less than what it costs many hospitals to provide care.þþThe data about hospitals is limited to the 100 most common causes of hospitalization, and the three-year comparisons apply only to the 95 reasons that were on the list in all three years. The data also applies only to patients enrolled in the traditional Medicare program. Data about people insured through private plans, called Medicare Advantage, is not part of this release.þþMedicare’s highest physician payments tended to go to specialists who administer expensive drugs in their offices, like oncologists, hematologists, ophthalmologists and rheumatologists. For the first time, the government separated the costs for those medications, called Part B drugs, from payments for more conventional medical care.þþThis information is especially valuable given the rising cost of newly approved drugs, especially those to treat cancer, said Cristina Boccuti, a senior associate at the Henry J. Kaiser Family Foundation who studies Medicare. “More visibility on Part B drugs, particularly cancer drugs, is helpful for understanding drug cost issues, which are increasingly important to Medicare.”
Source: NY Times
