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Editorial: Rein in Medicare billing excesses

In Garrison Keillor's Lake Wobegon, all of the children are above average. In too many doctors' offices in Florida, virtually all of the Medicare patients qualify for the highest billing rate. No wonder the Medicare program needs shoring up to ensure its long-term future.

A new analysis by ProPublica shows nearly 160 medical providers in Florida billed Medicare at the highest rate on a scale of 1 to 5 for nearly all of their visits for established patients. For example, Sarasota psychiatrist Matthew Edlund charged all 1,415 office visits by 188 Medicare patients at the highest level. A Sebring doctor in general practice and a doctor who practices emergency medicine in the Villages also had perfect records. The accuracy of all of those billings seems highly suspect, and such practices undermine the financial stability of Medicare. Many doctors find the Medicare reimbursement rates to be too low, but the answer is not to bill at the highest rate regardless of the complexity of the patients' treatment and the time spent with them.

Medicare pays for more than 200 million visits to doctors' offices each year. Taxpayers cover the cost for the visits by established patients, with the price ranging from an average of $14 a visit to more than $100. The billing codes are supposed to reflect the complexity of the treatment and the amount of time spent with the patient. In Florida, according to the ProPublica analysis, 585 medical providers billed at the highest rate for at least half of their office visits. The Centers for Medicare and Medicaid Services, which oversees Medicare, should be more vigilant about ensuring that public money is being properly spent and doctors are not overbilling.

This kind of aggressive billing is one reason why changes need to be made to Medicare, whose trust fund is projected to run dry in less than two decades. They should not be the sorts of changes envisioned by Sen. Marco Rubio, who last week embraced U.S. House Budget Committee Chairman Paul Ryan's plan to transform Medicare into a voucher program from a guaranteed benefit. That would transfer too much of the cost from general taxpayers to individual seniors, who would have to use the voucher to buy private coverage or Medicare coverage and could face higher out-of-pocket expenses.

Instead, Medicare should continue to look for cost efficiencies and adjust the financial incentives for doctors. The program already is on a smarter path to start paying doctors based on keeping their patients healthy rather than on how many times they examine them and which procedures they order. That should be good for patient health and for taxpayers — who should not be forced to pay some doctors the highest rate for every patient they see without adequate safeguards.

Editorial: Rein in Medicare billing excesses 05/16/14 [Last modified: Sunday, May 18, 2014 9:56pm]
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