For the first time this spring, Medicare released spending data for individual doctors and other healthcare providers, and an analysis by the nonprofit news outlet ProPublica examined doctors who were billing Medicare for the most complicated and therefore most expensive patient visits all of the time.
Data on Oregon provided by ProPublica to The Lund Report show that that 49 doctors and nurse practitioners in the state charged Medicare for the most complicated and expensive rate for every single one of their office visits with existing patients in 2012.
Most of the doctors had an extraordinarily small number of office visits. In Oregon, only 13 practitioners who always billed for top dollar had at least 100 Medicare office visits.
More than 1,200 nationwide practitioners who had at least 100 Medicare office visits charged Medicare 100 percent of the time for their complicated visits.
Nationally just 4 percent of office visits were for existing patients -- according to the ProPublica analysis, which found that the anomalous billing could be used to ferret out "cost-inflating errors and fraud."
Nationally, ProPublica found multiple examples of doctors already in trouble with their regulators for other medical malfeasance.
None of the Oregon doctors including the OHSU doctors have had any kind of public medical board sanction according to the publicly available records of the Oregon Medical Board.
At OHSU, officials dismissed the idea of any kind of billing problems, noting their their practitioners often see the most serious cases and their extensive reviews of billing practices catch any problems.
Officials noted that as a university hospital, OHSU gets referrals from around the state for patients who are in need of a specialist or a subspecialist who can help identify or manage a condition that general practitioners or other have not been able to treat, and it has the highest rate of severely ill patients in the state.
"Many of our physicians are practicing in a sub-sub-speciality,” Tom Heckler, OHSU’s chief executive of the faculty practice, told The Lund Report, noting other patients are referred to OHSU for care after less specialized physicians recommend their patients get help in the university setting.
“If we’ve got a kidney transplant patient (a couple of our doctors are kidney transplant nephrologists) or if you’ve got a complex neurological movement disorders patient, that patient has already been through primary care and a neurologist or nephrologist (as the case may be) and is at their third or fourth level of specialist to figure out the unique way to manage that problem or possibly to diagnose a problem -- in the case of a neurological disorder,” Heckler said.
“So what we’ve got is not a normal mix of people but the people that have been fed to us from colleagues around the state -- the 5,000 physicians that aren’t at OHSU.”
Roughly 1,000 doctors see patients at OHSU, Heckler said.
Overall, OHSU sees similar rates of Medicare billing compared to other university hospitals around the country and generally serves patients that have more serious conditions than other hospitals in the state, its officials noted.
The percentage of high-paid Medicare visits overall at the hospital are in line with other university hospital centers across the country, and OHSU ranks 10th in the nation among university medical centers on the acuity index, data provided by OHSU shows.
“To me the numbers make sense because it supports what we’re doing and is representative of the care we’re providing,” said Diana Gernhart, chief financial officer at OHSU Hospital.
OHSU officials said the university prides itself on its sterling reputation on billing, noting on balance Medicare audits have found OHSU had "downcoded" more often than "upcoding."
In the last seven years of the Recovery Audit Contractor program, OHSU's net Medicare revenue was approximately $1.6 billion, and the audits have found OHSU was overpaid 0.07 percent and underpaid 0.11 percent of the time.
The hospital spends $1.6 million a year on professional coding staff who automatically review any of the more expensive procedures such as surgeries and some of the office visits.
In addition, there’s no evidence in terms of dollars earned from Medicare that the 29 OHSU doctors and nurse practitioners were cashing in big. None were in the top 10 percent of Oregon providers earning money from Medicare, ranked by their specialty, according to the ProPublica data.
This article has been corrected to reflect the fact that just 13 Oregon practitioners who always billed for top dollar had at least 100 Medicare office visits.
Rachel can be reached at [email protected].
