California Doctors Among Those Charging Medicare the Most for Office Visits

Caption will go here. (John Moore/Getty Images)

More complicated office visits are billed at a higher reimbursement level and can cost patients more in higher copays. (John Moore/Getty Images)

By Lisa Aliferis, April Dembosky and Lisa Pickoff-White

When people think of seeing a doctor, generally the first thing that comes to mind is an office visit. But not all visits are the same. Frequently, patients have minor problems, which can be dispensed with quickly. Other problems are much more complex and require more of a doctor’s time and expertise. Not surprisingly, doctors get paid more for these more complex visits. Office visits for established patients are billed across five levels.

Three California doctors are among the top five nationally in billing for the most complex office visits.

Most doctors’ billing patterns to the Medicare program fall in the middle ground between simple and complex.

In California, only 5 percent of doctors’ office visits for Medicare patients were billed at the highest level in 2012. It is unusual for doctors to determine — and bill — a large proportion of their office visits as complex.

Now an analysis of Medicare billing data — which was made public for the first time last month — shows that three California doctors are among the top five nationally in billing for the highest number of the most complex office visits. In addition, they tended to bill at the highest level significantly more frequently than peers in their specialty. Continue reading

Look Up Your Medicare Provider

In April, Medicare 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. ProPublica created this application to help you find and compare providers.

Read more about the three California doctors who are among the top five nationally in billing for the highest number of the most complex office visits.

Prescription: Take New Medicare Data With A Dose of Caution

The data details payments to individual doctors, but experts warn against drawing sweeping conclusions from the numbers.(Getty Images)

The data details payments to individual doctors, but experts warn against drawing sweeping conclusions from the numbers.   (Getty Images)

By Mark Memmott, NPR

The headlines about one of Wednesday’s big stories — the release of data from 2012 about Medicare payment to doctors around the nation — are certainly serious sounding:

— “Sliver of Medicare Doctors Get Big Share of Payouts.” (The New York Times)

— “Small Slice of Doctors Account for Big Chunk of Medicare Costs.” (The Wall Street Journal)

— “Release of Medicare doctor payments shows some huge payouts.” (Los Angeles Times)

Here’s how The Associated Press sums up the news: Continue reading

Obama Signs Law to Fix Medicare Rate Gap in California

Under the new law San Diego, pictured above, will no longer be categorized as "rural." (vinhdicated/Flickr)

Under the new law San Diego, pictured above, will no longer be categorized as “rural.” (vinhdicated/Flickr)

A new federal law will change how doctors get paid in California, making it easier for patients in 14 California counties to find a doctor who accepts Medicare.

The law, signed by President Obama on Tuesday night, fixes an outdated Medicare formula that set rates based on urban or rural designations established in the 1960s, with places like San Diego, Sacramento, and Santa Cruz falling into the “rural” category.

So even as rent for office space and other costs of practicing medicine rose with the local economy in those places, doctors were still paid the same rates as doctors in remote, rural areas like Humboldt or Modoc. Continue reading

New Health Plan for the Poor and Elderly Raises Questions

Christina Kahn, manager of the San Mateo Health Insurance Counseling and Advocacy Program, returns phone calls to local seniors.

Christina Kahn, manager of the San Mateo Health Insurance Counseling and Advocacy Program, returns phone calls to local seniors. (April Dembosky/KQED)

A new experiment in managing the health of older Californians is causing a lot of confusion among seniors. Letters have been hitting mailboxes around the state this week with information about the changes. It’s the second letter in a series of three — the first went out in January — and they have been inspiring a lot of calls to county health insurance counseling centers.

“Why do they keep doing this to us old people?” asks a woman named Andrea, a 72-year-old resident of San Carlos. She called San Mateo County’s counseling office when she received her first letter, telling her she was going to be automatically enrolled in a new health plan — one she’d never heard of and never intended to sign up for.

“We get used to one thing and now we have to do something else?” she said. “I’ve gotta call quick. Otherwise I’ll get something, and maybe I don’t want that.”

Christina Kahn, manager of the Health Insurance Counseling and Advocacy Program of San Mateo County, has been returning phone calls like Andrea’s to explain. Continue reading

For Legal Immigrants, Obamacare Has Options for Aging Parents

A view of the the Statue of Liberty. (Timothy Clary/AFP/Getty Images)

A view of the the Statue of Liberty. (Timothy Clary/AFP/Getty Images)

Mohan Iyer has been in a bind. He’s lived in the U.S. since he came here for college from India in 1980. He ultimately got a job, a green card and became a citizen in 1994. Most of his siblings live here now, too.

After his father passed away two years ago, Iyer and his siblings have wanted their mother to move here. But there’s one big problem: she is effectively barred from any kind of reliable health insurance.

“Health care has been a big issue,” said Iyer, who is 50 and lives in Menlo Park.

New immigrants of any age can purchase health insurance on Covered California
That’s because new immigrants over age 65 are not eligible for Medicare. For legal immigrants like Iyer, who are people of working age, the impossibility of obtaining health insurance for their parents has been a barrier in their hopes of moving aging parents or grandparents to the U.S.

Americans over 65 tend not to worry much about health insurance, because of Medicare, the government insurance program for the elderly and the disabled. But while Medicare is available to virtually all citizens, starting at age 65, immigrants legally present in the U.S. for less than five years are not eligible.

And because of the very existence of Medicare, private insurance companies generally do not offer health insurance plans for those over 65. “There are health insurance options,” Iyer said, “but these are usually catastrophic traveler’s insurance. They usually have a very high deductible and they’re expensive.”

They also tend to exclude pre-existing conditions, he said. Continue reading

Are Medicare Advantage Plans Skimming Off Healthiest Patients?

By Jordan Rau, Kaiser Health News



New research finds that many seniors who switch from their HMO-style Medicare Advantage plan to traditional Medicare have higher levels of significant health problems, fueling concerns that the private plans cater to more profitable, healthy beneficiaries but don’t provide the most attractive care for the very ill.

More than 13 million people, a quarter of all Medicare beneficiaries, are enrolled in these private plans. Enrollment has been growing, in part because the plans often offer lower premiums than does traditional Medicare, as well as special perks such as free gym memberships.  Many Republicans want to build on them while capping the amount of money each Medicare beneficiary gets toward insurance. Democrats are disturbed the plans are more expensive than traditional Medicare and cut payments in the 2010 health law.

The federal government pays the plans a set fee for each enrollee. That has drawn concerns from some senior advocates that the plans have incentives to skim off the lowest-maintenance customers and leave the expensive patients to traditional Medicare. Continue reading

Fiscal Cliffnotes: If Medicare Eligibility Age Goes Up, People of Color Hit Hardest

While we all wait to see if President Obama and House Speaker John Boehner will hash out a deal on the fiscal cliff, one item getting a lot of discussion is raising the Medicare eligibility age, as I wrote about on Friday. Today, I was checking out Sarah Kliff’s twitter feed, and she pointed to UC Berkeley grad student Owen Zidar’s blog. Zidar’s post includes some eye-opening charts from economists David Card, Carlos Dobkin and Nicole Maestas writing in the American Economic Review.

Embedded in these wonky charts is an illustration of disparity:

And that disparity plays out in people not getting health care because of cost. Another snapshot of disparity:

This data was compiled before the Affordable Care Act was passed. We’ll have to wait and see how coverage and access change once the ACA is fully implemented in 2014.


Fiscal Cliffnotes: What Are the Trade-offs in Raising Medicare’s Eligibility Age?



It seems seductively easy: people are living longer, so why not raise the Medicare eligibility age from 65 to 67? This kind of entitlement reform is key to Republican strategies to pull the federal government back from the so-called Fiscal Cliff.

The problem is that while raising the Medicare eligibility age looks great in the short run, longterm it could actually cost money.

First, the short run: the non-partisan Kaiser Family Foundation says the federal government would save an estimated $5.7 billion in 2014 if the eligibility age were raised. Using a slightly different analysis, the nonpartisan Congressional Budget Office says savings could total $113 billion over the next decade.

But, those 65 and 66-year-olds are the youngest and presumably healthiest people in the Medicare program — meaning that if they leave Medicare, they would then be the oldest and presumably sickest people in any other insurance pool.

What would happen to those people? Continue reading

Fiscal Cliffnotes: 6 Health Care Questions, Answered

By Mary Agnes Carey, Kaiser Health News

(Graphic: Kaiser Health News)

(Graphic: Kaiser Health News)

The so-called “fiscal cliff” is a package of automatic spending cuts and tax hikes set to kick in next month unless President Obama and Capitol Hill agree on a way to stop them.

Negotiations to avert the cuts are ongoing and both sides have exchanged offers. On one side, the president and congressional Democrats have said they will reduce spending on entitlements, including Medicare, if Republicans will agree to increase tax rates on the highest earners.

And on the other side, Republicans have agreed to more revenue — but by closing loopholes and eliminating some deductions. They oppose raising tax rates.

Here are answers to six questions about what could happen in health care before the end-of-year deadline.

Q: If no deal is struck, how would that affect Medicare patients as well as the hospitals and physicians and other providers who care for them? Continue reading