Firestormm
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Examining the cost of too much care
25 May 2014
One doctor served prison time for health-care fraud. Another has been disciplined by regulators five times, on charges including dangerous overuse of anesthesia. A third devotes his practice to a controversial therapy that Medicare won’t cover.
That didn’t stop Medicare from paying them, even though they also billed in extremely unusual ways. They’re among 163 Texas caregivers who led the nation in per-patient use of certain procedures, a Dallas Morning News analysis of Medicare data shows.
Such billings don’t mean a doctor has done anything wrong or is out of compliance with Medicare rules. But experts say these patternsdo indicate potential overtreatment — a form of waste that costs U.S. taxpayers tens of billions of dollars annually.
The News analyzed 2012 payment data released last month by Medicare, the U.S. insurance program for elderly and disabled people. The data allows health care consumers for the first time to see how much their doctors bill Medicare and for what. Government officials said they also hoped the data would help expose misspending.
“We want the public’s help,” said Jonathan Blum, a senior Medicare administrator. “We want reporters’ help to identify spending that doesn’t make sense, that appears to be wasteful, that appears to be fraudulent.”
Researchers have found that up to 42 percent of Medicare patients experience unnecessary treatment. A 2012 report said Medicare and Medicaid, the government insurance program for the poor, waste up to $87 billion annually on “care rooted in outmoded habits, supply-driven behaviors and ignoring science.”
Dr. Donald Berwick, formerly Medicare’s top administrator, co-authored that report in The Journal of the American Medical Association. It identified overtreatment as possibly the largest single category of waste in Medicare and Medicaid.
“I don’t personally believe the majority of this is ill-intended or intentionally destructive or wrong on the part of doctors,” Berwick said in an interview. “A lot of times that has to do with knowledge transfer, and some doctors just lose track of what the science is saying.”
Jonathan Skinner, a prominent health-care economist, reviewed The News’ analysis.
“I think there’s overutilization and then there’s overutilization. The space you’re in is overutilization with a capital ‘O,’ ” said Skinner, a professor at the Dartmouth Institute for Health Policy & Clinical Practice. “This is not normal behavior.”
Skinner cautioned, though, that Medicare billing patterns don’t tell a complete story.
“It’s really hard to back out which physicians are providing low-quality care,” he said. “These data are very good at showing doctors who have tapped into the federal treasury, but they don’t tell you who’s the good or bad doctor.”
Texas outliers
Medicare paid the 163 Texas caregivers who had extremely unusual billings a total of $81 million in 2012. The News found 21 of them had previously been disciplined by the Texas Medical Board — including several who allegedly endangered their patients or otherwise practiced medicine unsafely. In general, board records show, the doctors admit no wrongdoing.
Dr. Jonathan Walker runs the Neurotherapy Center of Dallas. He also provides neurofeedback therapy, a controversial form of biofeedback.
One of them was Dr. Jonathan Walker, who runs the Neurotherapy Center of Dallas. It advertises drug-free treatment for problems such as seizures, autism, dyslexia and sports-related head injuries.
In 2012, Medicare paid Walker for 1,302 medium-complexity office visits with 60 patients. That rate, 21 visits per patient, was nearly 80 percent higher than the next-leading neurologist in the nation and over 15 times the national average. Walker received about $70,000 for those office visits — the only thing for which he billed Medicare.
Walker said he sees patients much more often than his peers because he provides neurofeedback therapy. It’s a controversial form of biofeedback based on the idea that patients, through a long series of training sessions, can learn to control their brain waves and thus their neurological disorders.
A typical training includes 30 minutes of watching a film or playing a video game while electrodes record brain waves. If the electrodes detect what’s deemed abnormal activity, the patient gets negative feedback — a fuzzy screen, for example — until brain activity returns to normal. Walker said he follows up by talking with patients “about changes they’ve noticed associated with the procedure.”
Medicare doesn’t pay physicians for the kind of biofeedback Walker performs, according to its billing rules. Walker acknowledged that and said he thought it should be a Medicare-covered expense. “We ask them to pay for the follow-up visits in lieu of paying for the training,” he told The News.
Office visits must be for medically necessary treatments or exams, the billing rules say. Medicare officials declined to comment on Walker’s case or other individual caregivers.
The Texas Medical Board has disciplined Walker twice for using or recommending unconventional practices...
Read more: http://www.dallasnews.com/investigations/20140524-examining-the-cost-of-too-much-care.ece
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