Tyler Ophthalmologist Tops List of Texas' Top Medicare Billers

Categories: Healthcare

Opthalmologywikipedia.jpg
PFrankoZeitz
Opthalmology, apparently, is where the big Medicare money is.
On Wednesday, the federal government released a massive trove of Medicare data showing how much some 880,000-plus U.S. healthcare providers were paid for their services in 2012. Fully mining the data will take months or years, but using the data to compile a list of the top Medicare billers took mere minutes.

Texas doesn't have any villains quite as convenient as Dr. Salomon Melgen, a West Palm Beach ophthalmologist who both received $21 million in Medicare payments and looks vaguely sinister in pictures, but it does have its fair share of doctors and lab that annually bill the federal government for millions of dollars.

The Wall Street Journal, among others, has put the data into a searchable database, which allows sorting by state and city.

Topping the list in Texas are clinical labs like Quest Diagnostics, whose Irving and Houston locations received a combined $80.2 million, and Laboratory Corporation of America, whose Dallas and Houston locations were paid a combined $74.9 million. Houston's Proton Therapy Center is the first non-lab on this list, coming in at No. 9 with $8.7 million in Medicare reimbursements. Rounding out the top 10 is the city of Houston's ambulance service, which gets $8.7 million. Here's the list:

MedicareTop10.JPG

And what doctors and practices, outside of labs and ambulance services, are the most prolific? Hundreds received more than $1 million from Medicare. Here are Texas' top 25:

MedicareTop25.JPG

None of this is to imply that any of these providers are doing anything wrong. There are plenty of reasons for a high Medicare reimbursement rate, like treating a lot of elderly patients. As the New York Times notes, this is highlighted by ophthalmologists, who comprise roughly half of the top 100 billers nationwide.

In ophthalmology, for example, a small number of doctors are able to perform high numbers of well-paid cataract surgeries or give numerous injections to patients with a serious eye disease known as macular degeneration, a condition that can, if left untreated, lead to blindness. They are also likely to treat a large share of Medicare patients in their practices.

"There are just these pockets of profitability within the system," said Dr. Lisa Bielamowicz, executive director and chief medical officer for research at the Advisory Board Company.

Ophthalmologists say that their high representation among the list of big recipients is misleading. Much of what Medicare pays them, they say, goes to the cost of the drugs they administer to patients in their offices and the bulk of that money ultimately goes to the drug companies.

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29 comments
animas
animas

Sadly, transparency regarding the administrative costs which go into the pockets of bureaucrats is almost never discussed.  If CMS/HHS would just update their computer systems, excess  cost for administration salaries could be significant.

ryan762
ryan762

I'm going to have to have a talk with my father about the need for him to start seeing more patients. He only got $240,000 from Medicare in 2012. That's not even $1,000 per work day.

holmantx
holmantx topcommenter

When the consumer of healthcare is not directly responsible for the payment of it, cost will never be controlled.  Over 50 cents of every medical dollar spent in America prior to Obamacare was spent by government.  And had the government not collapsed the entitlements by spending the trust funds, there would have been no reason to cook up a new scheme to mask the malfeasance.

If we did not have such a thing as an airplane today, we would probably create something the size of NASA to make one. H. Ross Perot (b. 1930), U.S. business executive, presidential candidate 1992. Quoted in: Newsweek (New York, 1 Dec. 1986).


TheRuddSki
TheRuddSki topcommenter

West Palm is, like most of Florida, chock full of retirees, and I'd wager that Florida Medicare docs are well-represented overall.

But the Dallas eye doc, does this mean the Dallasites lack vision? That might explain the standing wave, the silly bridge, the water taxis, the Democrat vote and the fact y'all are up to your asses in goat bones.

wcvemail
wcvemail

On the face of it, the opth's have reasonable grounds for being at the top. I understand that the drug Lucentis in particular is hideously expensive.

OTOH, why do two opth's in Tyler lead the list? Surely there are other opth's in East Tx for referrals. The next step is trace that money. The FL doc and another like him donated millions to Congress critters to stave off investigations; the poster child even hired the former head of HHS investigations to defend the doc. In fact, that FL doc was part of the mud spattered on Rep. Menendez (D-NJ), who got to ride on the doc's private jet and received millions in return for calling off investigators.

animas
animas

@animas  this should read "If CMS/HHs would just update their computer systems savings of excess costs for redundant administrative salaries could be significant" (sorry)

animas
animas

@holmantx  The most recent analysis of administrative -chiefly gov bureaucratic costs-  vs provider costs, (of which I am aware), was published over a decade ago and indicated that the percentage of Medicare dollars going to individual providers (Physicians eg exclusive of corporate, academic or hospital employment) was approximately 11% for ALL specialties.This means that even if the physician providers were paid 0% by Medicare, costs would continue to be excessive.

RTGolden1
RTGolden1 topcommenter

@holmantx "A democracy cannot exist as a permanent form of government. It can only exist until the majority discovers it can vote itself largess out of the public treasury. After that, the majority always votes for the candidate promising the most benefits with the result the democracy collapses because of the loose fiscal policy ensuing, always to be followed by a dictatorship, then a monarchy."  quote unattributed.  I've seen it quoted as Jefferson and as Tytler.

Regardless of where the quote comes from, it is interesting to apply it to the last 100 years of American democracy and see how accurate an observation it is.

TheRuddSki
TheRuddSki topcommenter

@holmantx

Hell, the admin is reportedly spending 1.5 billion bucks to try and convince people to sign up with the policy everyone demanded, and that's not counting the in-kind contribution from major media and Hollywood (but they would never disobey direct orders from Il Duce)

Funny thing though, in all the advertising, begging, pleading and stern lectures, all the Late-night shows, comedy shows and other hard-news outlets, you'll never see or hear the words "penalty" or "tax".

holmantx
holmantx topcommenter

@TheRuddSki  

I used to live in West Palm Beach.  On Singer Island.

That was back when summers lasted three or four years.

dmtrousd
dmtrousd

Tyler is a major health care hub for East Texas. It's simply a big catchment area for that rural region, much like Scott & White in Temple.

There is also quite a lot of advanced cardiac surgery done in Tyler, as well as other care usually associated with big cities.

holmantx
holmantx topcommenter

@RTGolden1 @holmantx  

He was, at the time, writing of the fall of the Athenian Republic.  When a society bases its political power on a majority vote, it is inevitable that those wishing to have power will seek to satisfy the needs of those who will provide it (vote) by transferring wealth.  This leads to ever increasing public spending fueled by the self-interest of producers. With each increment in the common realm, more people are brought into the class of those receiving benefits . . . these people will take their benefits into account, desire to maintain or increase their level of benefits, vote for those who will support them, and thus, the level of spending will ever increase. The needs of the voters will eventually exceed the treasury’s ability, so fiscally unsound policies will be undertaken.

We may have crossed the Rubicon.

holmantx
holmantx topcommenter

@TheRuddSki  

Ultimately, it will take hard men with guns to enforce tyranny.

Some people just ain't gonna sign up.

Like the 40 million utes (ha!).  They don't need no stinkin' insurance, and they ain't gonna pay like middle-aged men.

Hell, that's their first car.

TheRuddSki
TheRuddSki topcommenter

@holmantx

Isn't Singer part of Riviera Beach? Been so long, so much has changed. At the north tip of PB Island used to be a small fishing peir & bait shop. I seem to remember it being directly across the inlet from either Peanut Island or Palm Beach Shores, only back then, I didn't know it was named that, it was just woods - now it's all housed. I just visited last fall, been almost 40 years!

The bait shop is gone, but really, not a whole lot in PB has changed, except now everyone has let their hedges grow to 20 ft tall as a privacy thing, I could barely see our old house on Ridgeview Dr.

One reason I prefer the West Coast now is because it reminds me of the Florida of the 60's and 70's, when it was still pretty wild between Lauderdale and Palm Beach - now is all condos, etc.

The little ferry still runs from Palm to West Palm, that surprised me.

wcvemail
wcvemail

@dmtrousd  
Thanks for that info. I suspect the same is true for Amarillo in its region.

holmantx
holmantx topcommenter

@RTGolden1 @holmantx  

There will be another natural breakpoint.

These accumulating Trillions in debt are nothing more than a claim on future labor.  The generations behind the Baby Boomers will not labor, to the extent they will have to, in order to repay such a staggering sum.  It violates the Law of Self Interest.  It is why the Soviet Union collapsed.  It's a worn out postulate that socialism cannot work due to the Law of Self Interest, but it really is true.  Humans will never labor hours every day if they do not receive the direct benefit of that labor.  It is a very real form of human bondage.

Our politicians have always counted on repaying these trillions with inflated dollars, but the deficits have gotten away from them.  And there is a very real danger we may enter a period of deflation (depression), which would exacerbate the situation.

I think what is most probable is that the generations behind the retiring Yuppies and their unborn will refuse to labor to the extent we've loaded them up with.  The public sector will collapse financially, the reimbursements to the states will stop, and they will be on their own.  Like the old Soviet Union, we will disassociate to some extent.  I see no other outcome than a federal default on its debt, followed by civil disobedience and a dark period of reconstruction.

RTGolden1
RTGolden1 topcommenter

@holmantx @RTGolden1Not yet, we are not at a point where 51% of people do not share significantly in the tax burden.  When we reach that point, the system is beyond repair.  At that point, tax and spending policies can do nothing but accelerate on the path to ruin.  People are too stupid to realize that too much of a good thing is ruinous in government policy, just as it is in most other aspects of life.

TheRuddSki
TheRuddSki topcommenter

@holmantx

I think that's the plan with Amnesty or an EO, which, of course, is the final end to immigration law pertaining to points South.

It ain't gonna be pretty.

TheRuddSki
TheRuddSki topcommenter

@holmantx

When it passed, a girl at work told me "great, now I can get my kids insured!"

I asked her why she hadn't previously, she said she "just didn't want to spend the money"

Short version: When I told her she HAD to now, or face a fine, her jaw dropped - she thought I was bullshitting, she thought it was euro-style socialized medicine. When she realized I was truthifying, she was pissed.

What would we do without our precious low-information voters?

RTGolden1
RTGolden1 topcommenter

@holmantx The Ute Indian Tribe already enjoys full, government single-payer healthcare.  Ask them if they like it.

TheRuddSki
TheRuddSki topcommenter

@holmantx

I moved there from PR shortly after the assassination, stayed four years, then to CT & NY, then back to Fl for another four years, we maybe even crossed paths. I assume you surfed LOL.

I gotta say, for all it's faults, I love Florida, but not so much the Gold Coast anymore, I prefer the Bonita to Sarasota area now.

Daytona, St Augustine and the Space coast are decent, but cold in the winter!

holmantx
holmantx topcommenter

@TheRuddSki  

sounds like the same time frame - 1962-63, I think.  I remember standing on the side of the road at Cape Canaveral, watching this patch of red hair go by.

President Kennedy motorcade.  My mother took the herd out there where we stood around for hours to see him blaze by in seconds.

The day he was assassinated, I was in grade school in Scottsdale, AZ, so it had to be 1962 time frame.

TheRuddSki
TheRuddSki topcommenter

@holmantx

Since there was no bridge across that inlet, I don't think I ever actually got over to Riviera Beach, even tho it was a stones throw.

Went to West Palm a lot of course, movies, etc. used to ride my bike to the train yard /tracks, which meant going through the black areas. Never got hassled.

That changed considerably in the seventies tho.

holmantx
holmantx topcommenter

@TheRuddSki  Riviera Beach.  I was 9 or 10, I guess.  I hung out on the docks where the charter boats came in.  I'd get the skippers to give me the shark teeth.  

wcvemail
wcvemail

@holmantx  
Time to update T-Bone Walker's "Stormy Monday" with the "Eagle flies" reference, good one.

Ironically, the largest concentration of Americans outside the U.S. (about the turn of the century) was in and around Guadalajara, Mexico. This was counted by the number of green SS checks mailed through USPS to the retirees there. Presumably the local doctors benefited greatly. Now it's the other way around.

holmantx
holmantx topcommenter

@wcvemail  

The Pharr Edinburg McAllen MSA should have blown those guys off the charts.  Combined with the winter Texans, high poverty, and flow across the border (Americans have no idea the massive traffic daily across the border post offices to pick up govt checks), it should have been a no brainer.  Unless it is unrecorded.

I was 800 miles west of that MSA and there was a line 100 yards long at the border post office.

Picking up checks.

The Eagle flies.

This country has no idea how many Mexican citizens have applied for, and received, green checks.   An amazing spectacle every two weeks.

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