Medicare Payments to Providers in 2012
Newly released Medicare billing data show total payments to more than 880,000 medical providers in 2012, totaling $77 billion.
Search the database by provider name, specialty and location to see the types and number of procedures performed and the amounts paid to each provider by Medicare. Related article.
Use your new powers for Good.
At least, not in real life:
The idea that “failure is not an option” is a fantasy version of how non-engineers should motivate engineers. That sentiment was invented by a screenwriter, riffing on an after-the-fact observation about Apollo 13; no one said it at the time. If you ever say it, wash your mouth out with soap. If anyone ever says it to you, run. Even NASA’s vaunted moonshot, so often referred to as the best of government innovation, tested with dozens of unmanned missions first, several of which failed outright.
Failure is always an option. Engineers work as hard as they do because they understand the risk of failure. And for anything it might have meant in its screenplay version, here that sentiment means the opposite; the unnamed executives were saying “Addressing the possibility of failure is not an option.”
Healthcare has this idiocy. It’s a disconnect between the doers, who will tell you what’s possible, and the managers, who either don’t know or don’t remember.
Leaders, by the way, would know the difference. Need more of those.
NEJM realized the PQRS Emperor has no clothes.
Perhaps the only health policy issue on which Republicans and Democrats agree is the need to move from volume-based to value-based payment for health care providers. Rather than paying for activity, the aspirational goal is to pay for outcomes that take into account quality and costs. In keeping with this notion of paying for value rather than volume, the Affordable Care Act ACA created the “value-based payment modifier,” or “value modifier,” a pay-for-performance approach for physicians who actively participate in Medicare. By 2017, physicians will be rewarded or penalized on the basis of the relative calculated value of the care they provide to Medicare beneficiaries.
Although we agree that value-based payment is appropriate as a concept, the 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. Yet the medical profession has been remarkably quiet as this flawed approach proceeds.
How many tens of thousands of hours are spent jumping through hoops like these that turn out to be more meaningless (or worse) ‘government work’?
All the articles about cancelled Individual Insurance plans have some variation of this spin in them:
For some who have received the letters, the new plans being offered are more expensive, but for others — especially those who qualify for a federal subsidy to bring down the cost of the premium — their insurance bill will go down.
Here’s the thing: people (like me) in the Individual market don’t have IBM or Exxon sitting across the table from an insurance company, dealing from a position of some strength. We’re individuals. We’re independent Contractors (me), self employed and scraping by, or doing well. We looked at our options, bought plans we could afford, and realized there are tradeoffs from a cost/benefits standpoint. Not a lot of people in that group bought a soup-to-nuts expensive plan (some did, most don’t).
The emphasized thing above is pure spin on the part of the writers. I have no doubt they’ve been told this over and over, but I have yet to see one article about someone in the Indy market that got a ‘better’ plan that dropped in price. There will be a few, but most if not all will see their costs go up.
Just so you see it for what it is.
A constitutional argument. From docs:
The Association of American Physicians & Surgeons (AAPS) has filed a lawsuit today in federal court to halt the unlawful revisions to ObamaCare (the Patient Protection and Affordable Care Act).
The separation of powers required by the Constitution prohibits the executive branch—the Obama Administration—from rewriting laws passed by Congress. Yet that is what Obama has done by changing key parts of ObamaCare in order to implement it.
The AAPS lawsuit, which was filed today in the Eastern District of Wisconsin, asks the Court to enjoin the Obama Administration from imposing its “individual mandate” while delaying the “employer mandate.” The law that was passed by Congress in 2010 requires that the employer mandate go into effect at the same time as the individual mandate: Jan 1, 2014.
“The U.S. Constitution requires a strict separation of powers between the three branches of government, such that the executive branch cannot change laws passed by Congress,” AAPS’s lawsuit explains. By imposing the individual mandate in 2014 without the protection of the employer mandate, the Obama Administration has changed the legislation passed by Congress.
Bizarre congress is super-cool with the executive branch picking and choosing the laws to bother enforcing.
I’m not usually up this early. Ate a lot of carbs last evening, paying the price all night. And today. Probably tomorrow, from the course of events.
Enough about me. This is a nice summary of thoughts on Obamacare:
…What do we have to look forward to? Obamacare in effect outlaws traditional insurance and substitutes in its place a mandatory system of prepaid health care administered by the kind and gentle souls who run insurance companies, which is in fact in many ways similar to the mandatory health-savings accounts in Singapore — minus the property rights, wealth building, heritability, efficiency, and consumer choice. Likewise, Obamacare is in some ways similar to the Swiss system, but without the downward price pressure associated with high out-of-pocket expenses, and, as we have seen in recent weeks, also minus the competence and efficiency. As they say in Switzerland: Ich be chrank.
And it is worth remembering that under Obamacare there will still be millions of Americans with no health-insurance coverage, while many (and possibly most) of those added to the coverage rolls will simply be given Medicaid cards,…
Speechless, I am.
The top part of the article is typical Klein (intent is all that mattered, not execution, which he only allows to one party), but his writing about government in general and government IT in particular is interesting:
The saga of healthcare.gov has been a symphony of government inefficiency. The effort, directly overseen by the IT department of the Centers for Medicare and Medicaid Services, involved no fewer than 55 contractors. The process was thick with lawyers and political interference. In violation of current best practices in the software world, the code was kept almost entirely secret; other engineers weren’t able to point out its flaws, and it wasn’t tested rigorously enough. The Obama administration has been assailed for not calling in Silicon Valley’s top minds to collaborate, but that misses the fundamental problem: The best coders in the Valley would’ve never agreed to work under such deadening, unpleasant conditions.
There are people in Washington who share Bracken’s views, but their struggle against bureaucratic inertia can seem Sisyphean. “Government becomes really afraid of failure, which is a bit ironic, as this ends up leading to failure,” says Clay Johnson, a technologist who was one of the White House’s presidential innovation fellows. “But that fear of failure leads them to only want to work with known quantities, and known quantities mean contractors who’ve done this work in the past. That puts them with a group of entrenched vendors who haven’t really had to compete in the world of technology.”
That fear of failure has been institutionalized in the way the federal government awards contracts. The complex, arcane process favors those companies that devote resources to mastering it and repels the Silicon Valley startups the government desperately needs. “I realized I could figure out how to develop these very complex, very new software programs, or I could figure out how to contract with the government,” says Trotter, who worked on health IT projects with the Veterans Administration. “And so I chose to do the thing that was innovative.”
The front end of the website will eventually get fixed, then the back end. Then we’re going to wait for the employer mandate to hit. All this market disruption was just the self-insured, a very small piece of the health insurance pie.
Wait, wait, this was supposed to bend the cost curve Down…
It is also ironic that high-deductible, catastrophic plans are precisely what young people should be buying in the first place. They are inexpensive because they provide coverage for unlikely, but expensive, events. Routine care is best paid for out-of-pocket by value conscious consumers. But Obamacare outlaws these plans, in favor of what amounts to prepaid medical treatment that shifts the cost of services to taxpayers. In such a system, patients have no incentive to contain costs. Since the biggest factor driving health care costs higher in the first place has been the over use of insurance that results from government-provided tax incentives, and the lack of cost accountability that results from a third-party payer system, Obamacare will bend the cost curve even higher. The fact that Obamacare does nothing to rein in costs while providing an open-ended insurance subsidy may be good news for hospitals and insurance companies, but it’s bad news for taxpayers, on whom this increased burden will ultimately fall.
Lack of skin in the game.
Read and weep. My comments in [brackets]:
…[interviews with medical insurance policy-type reps in Washington]
One key worry is based on the fact that what they’re facing is not a situation where it is impossible to buy coverage but one where it is possible but very difficult to buy coverage. That’s much worse from their point of view, because it means that only highly motivated consumers are getting coverage. People who are highly motivated to get coverage in a community-rated insurance system are very likely to be in bad health. The healthy young man who sees an ad for his state exchange during a baseball game and loads up the site to get coverage—the dream consumer so essential to the design of the exchange system—will not keep trying 25 times over a week if the site is not working . The person with high health costs and no insurance will . The exchange system is designed to enable that sick person to get coverage, of course, but it can only do that if the healthy person does too . The insurers don’t yet have a clear overall sense of the risk profile of the people who are signing up, but the circumstantial evidence they have is very distressing to them . The danger of a rapid adverse selection spiral is much more serious than they believed possible this summer . They would love it if the administration could shut down the exchange system, at least the federal one, until the interface problems can be addressed. But they know this is impossible .
A terrifically scary article (read it all ™), but this paragraph has so much implied information in it it jumped out as needing some amplification.
1: Why would he? He’s actuarially bulletproof, and has as much need of medical insurance as he does a 401k (unemployment joke), but seriously: this youngster is the basis for paying the ACA bills. If the young and healthy and unlikely to need medical insurance don’t sign up the ACA insurance house of cards collapses (see next):
2: Why wouldn’t they? This is the group the ACA is aimed at, those who can’t get insurance at all, or who have it (Cobra, etc), but for this group insurance is prohibitively expensive. Were I in their shoes I’d be hitting this site 18 hours a day and not quitting until I got insurance and a subsidy. Hint, this group is very to horrifically expensive, and require their costs to be spread far and wide for insurance to work.
3: To belabor the point, insurance companies don’t print money to pay bills, they transfer money from the payments of those paying for insurance who don’t wind up using it to the bills of those who do. Therefore not enough insured paying (but not using) the insurance company runs out of money, then the insured aren’t insured when the company goes broke. That’s ungood.
4: Insurance companies understand medical cost risk like no other group, and were this good news for them (non-distressing news) they’d be singing this to the heavens/news, as a way to sign up the  group. Then it’d be ‘cool!’, which would cascade into more young/well signups.
5: This is inexplicable. Insurance companies abhor risk, this was a completely foreseeable risk in an unknown situation, unless there were some significant assurances from On High that Nothing Can Go Wrong. Which they would be dumb to just swallow whole. This part of the mechanism of bargaining still bugs me, as I don’t have an explanation for why an entire, smart and profitable industry would buy into a scheme that could destroy it quickly and painlessly. Remember this, they walked into the ACA eyes wide open.
6. It’s hard to stop a process bought into under a combination of duress and greed, either objection draws credibility into question.
No secret, I’m totally against (and aghast at) the ACA. That said, it’s more than curious a nation that put men on the moon with slide rules cannot make an insurance marketplace with roughly a half a billion dollars and a three year head start.
Know how you know the ACA is a disaster? Everyone who can is pulling strings to avoid it:
Lawmakers and staff can breathe easy — their health care tab is not going to soar next year.
The Office of Personnel Management, under heavy pressure from Capitol Hill, will issue a ruling that says the government can continue to make a contribution to the health care premiums of members of Congress and their aides, according to several Hill sources.
We’re all second class citizens outside the beltway.
I particularly like the graphic…
By the end of this week, states must decide whether they will build a health-insurance exchange or leave the task to the federal government. The question is, with as many as 17 states expected to leave it to the feds, can the Obama administration handle the workload.
“These are systems that typically take two or three years to build,” says Kevin Walsh, managing director of insurance exchange services at Xerox. “The last time I looked at the calendar, that’s not what we’re working with.”
Frankly, it’s too much work for any administration. Absurd to think it’s workable given any timeframe.
As a Swede currently living in the United States, with actual experience of Swedencare, I must reply to the delusions propagated by professor Robert H. Frank in his June 15 article in the New York Times, titled “What Sweden Can Teach Us About Obamacare.”
It is surprising to read something so out of line with basic economic theory from an economics professor. But theory aside, it would have sufficed for professor Frank to have taken a field trip down to the nearest public emergency room to have his illusions irreparably shattered. The reality is that Swedish healthcare is the perfect illustration of the tragedy of central planning. It is expensive and — even worse — it kills innocent people.
There is nothing economically mysterious about health care — it is just another service. Like any other it can be plentifully provided on a free market at affordable prices and constantly improving quality. But like everything else, it breaks down when the central planners get their hands on it, which they now have. To claim that the problems are due to a “market failure” in health care is like saying that there was a market failure in Soviet bread production.
Others have been down this path, do we have to do it in the typically American governmental (expensive, borderline incompetent) version? Can’t we just jump to the free market?
The American Medical Association AMA just concluded their Annual Meeting of the House of Delegates in Chicago on Wednesday, June 19th. And it seems as if the profession of pharmacy was a topic of conversation. According to the AMAWire, one of the points of discussion for the delegates this year was pharmacist inquiries with practitioners to verify controlled substances. This is the statement they released in response that you will find on the AMA’s website: The AMA delegates “Issued a warning against “inappropriate inquiries” from pharmacies to verify the medical rationale behind prescriptions and diagnoses, calling them unwarranted interference with the practice of medicine.” Forgive me for being a bit confused about the last part of that statement. I’ve always been under the impression that the duty of a pharmacist was to ensure prescriptions were written for a legitimate medical condition in the course of a practitioner’s normal scope of practice. If we are being accused of interference, shall we then be relieved of all responsibilities toward ensuring the best interests of our patients? Are we not the drug expert profession that is the last stop in the chain of treatment from provider to the patient?
Via @medskep on twitter:
Many scoff at the term “death panel” — Sarah Palin’s morbid, if misleading description of the powers contained in U.S. government health-care legislation back in 2009. Yet there was a grain of truth in that infamous noun phrase. The fact of the matter is that all health-care systems have “death panels” of one sort or another. It’s just a question of who sits on them — bureaucrats, insurers or doctors — and what label we put on their functions.
There’s the truth, let’s not act like it isn’t.