Morning Briefing
Summaries of health policy coverage from major news organizations
Large Release Of Medicare Billing Data Details How Billions Of Health Care Dollars Are Spent
The New York Times: Data Shows Large Rise In List Prices At Hospitals
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. But 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. (Sanger-Katz and Thomas, 6/1)
The Associated Press: Vast Trove Of Medicare Data Details How Billions Are Spent
Joint replacement was the most common hospital procedure that Medicare paid for in 2013, accounting for nearly 450,000 inpatient admissions and $6.6 billion in payments. Among physicians, cancer specialists received the largest payments from Medicare, but much of their reimbursements went to cover the cost of the very expensive drugs to treat their patients. (Alonso-Zaldivar, 6/1)
The Wall Street Journal: Small Group Of Doctors Are Biggest Medicare Billers
A small cadre of doctors and individual medical providers are consistently the biggest recipients of Medicare dollars, new government data show. The top 1% of billers of the federal program in 2013 reaped 17.5% of all payments to individual providers that year. That same cluster of doctors and other individual providers received 16.6% of the program’s payments in 2012. (Weaver, Barry and Stewart, 6/1)
Bloomberg: At Least 3,900 Medicare Millionaires Revealed In U.S. Data
A small group of doctors accounted for a large chunk of Medicare payments once again, data released today by the U.S. government show. Medicare paid at least 3,900 individual health-care providers at least $1 million in 2013, according to a Bloomberg analysis of data from the Centers for Medicare & Medicaid Services. Overall, the agency said it released data on $90 billion in payments to 950,000 individual providers and organizations. On average, doctors were reimbursed about $74,000, though five received more than $10 million. (Tracer and Chen, 6/1)
USA Today: Mental Health Spending Up, New Medicare Data Shows
Medicare providers got more for mental health and specialty care including sports and sleep medicine in 2013, according to new payment data released Monday that shows which healthcare providers received the most money. A USA TODAY analysis also found Medicare payments in more traditional areas of medicine -- including cardiology, general practice and geriatric medicine -- were all down. (Hoyer, Ungar and O'Donnell, 6/1)
In other Medicare news, Politico Pro reports on a new study examining Medicare Advantage billing practices, while The Wall Street Journal notes that the Advantage program adds to Humana's value -
Politico Pro: Medicare Advantage Paying Billions Through Upcoding, NBER Study Finds
The federal government is spending about $10 billion too much each year on Medicare Advantage plans because of “upcoding” by insurers, a new study finds. The rates private Medicare plans get paid are dependent on scores indicating how sick, and therefore expensive, their customers are. That creates an incentive for insurers to boost those scores in order to reap higher rates. (Demko, 6/1)
The Wall Street Journal: Humana’s Pricey Medicare Prize
Humana, the health insurer reportedly on the block, has a rare asset to sell, with a lofty valuation to match. The prize embedded within Humana, the fifth-largest U.S. managed-care company by market value, is its stronghold in Medicare Advantage, the privately run version of the government program. The aging American population makes a strong Medicare presence desirable. (Grant, 6/1)
Also, the Fiscal Times questions the role of a key panel in determing Medicare's physician payments -
The Fiscal Times: A Conflict Of Interest In The Way Medicare Pays Docs?
A small but powerful panel of physicians has long played a major role in determining how much the federal government pays its Medicare doctors. The problem, according to auditors from the Government Accountability Office, is that the panel’s recommendations rely “on the input of physicians who may have potential conflicts of interest with respect to the outcomes of CMS's process.” (Ehley, 6/2)
