Thursday, April 10, 2014

The New York Times can't read and write and

think for if they did they would see that the simple application of BCG in the US would reduce healthcare costs, protect people from multidrug resistant TB and mitigate autoimmune diseases (see faustmanlab.org
and pubmed.org faustman dl and pubmed.org ristori bcg


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Dr. Ardis Dee Hoven of the American Medical Association is worried about the accuracy of publicly released Medicare data. Credit Ted Grudzinski/AMA

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The release on Wednesday of Medicare payment data is getting mixed reviews from doctors. Many say they favor sharing information but worry that the data presented by Medicare omits important details and may mislead the public and paint an unfairly negative picture of individual doctors.
Dr. Gary Heit, a recently retired neurosurgeon in Redwood City, Calif., said he thought some of the details revealed could be useful to patients who want to make sure that the physicians they choose are experienced — say in carotid-artery surgery, where more operations performed correlate with better patient outcomes.
“Being able to track the number of procedures is incredibly valuable,” Dr. Heit said. “I think the ability to see the number of cases a physician does is really important.”
However, the data only include treatments given to certain Medicare patients.
Many other doctors worried that the data released was incomplete and often misleading. In some cases, enormous payments that seem to be going to one doctor are actually distributed to multiple others. But the data tables do not reveal that the money was shared.
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The highest-paid 2 percent of doctors received almost one-fourth of Medicare payments.
Share of Medicare payments to doctors
BILLIONS
TOP 2%
23.6%
$15.1
REST OF
TOP 25%
52.1
33.3
BOTTOM
75%
24.3
15.5
TOTAL
100
63.9
For instance, Dr. Jean M. Malouin, a family medicine physician at the University of Michigan Health Systems, shows up as one of the top Medicare billers in the country, collecting payments of $7.58 million in 2012 for more than 207,000 patients. But Dr. Malouin directs a Medicare project that involves 1,600 primary care physicians, who each receive a small payment each month. Those payments are funneled through Dr. Malouin. The doctor’s situation is described in a website that the hospital set up on Wednesday to help explain the data to the public.
Dr. David L. Longworth, chairman of the medicine institute at the Cleveland Clinic, said the data could also be misconstrued because it does not explain that some doctors treat unusually ill patients who need a great deal of complex, time-consuming care, for example those with heart failure or advanced cancers. People who focus only on the payments may assume that doctors who receive more money are doing something wrong, he said.
He also noted that some doctors who work as salaried employees of group practices like the Cleveland Clinic do not receive the amounts that show up alongside their names in the data tables because the Medicare payments go to their institutions.
Aaron K. Albright, director of the Media Relations Group at the Centers for Medicare and Medicaid Services, said the information was not misleading but simply “represents payments made to the providers for the services they provide.”
Dr. Ardis Dee Hoven, president of the American Medical Association, said her group was concerned about the data’s accuracy because of what she described as a history of mistakes in Medicare’s database. She also noted the lack of any information about the quality of services.
“We were told we would have an opportunity to see this data before it was publicly produced, and we were not,” Dr. Hoven said.
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Mr. Albright said he did not know of any promise made to the medical association about seeing the data before it went public.
Dr. David A. Fleming, president-elect of the American College of Physicians, said his group favored transparency, but added: “One concern is that this is a huge data dump, and a lot of interpretation is occurring without the data actually being analyzed, with exposure of physicians who have been paid huge amounts of money. I understand the implications, but there may be very legitimate reasons as to why.”
Oncologists, who receive some of the highest Medicare payments, are among those who feel most unfairly treated by the data because the tables do not make it clear that the payments must also cover their overhead — expensive chemotherapy drugs and the salaries of nurses and other professional staff.
Dr. Robin T. Zon, an oncologist in South Bend, Ind., is listed in the Medicare tables as having received more than $1.2 million in 2012, but she said that 90 percent of it went to overhead.
Some doctors feel a bit vulnerable and exposed by having details about their income posted on the Internet for the whole world to see. “I have very mixed feelings because I think there’s a lot of stuff about doctors that’s already on public records, and it makes me anxious we’re being examined to that extent,” said Dr. Ulrike D. Sujansky, an internist in San Mateo, Calif.
“It’s public record what prescriptions I prescribe. And that information is also sold to the pharmaceutical companies,” Dr. Sujansky added. “Anybody can look up if I have lawsuits. And now they’re going to find out what my billings are. It does feel very invasive and intrusive.”
But she also said: “I am pleased that light is being shed on the fact that some physicians clearly do procedures for financial gain and not for the benefit of the patients.”

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