Daily Rounds: Rampant Medicare 'Up-Coding'; PAs On Rise; Hospice For Killebrew; More OTC Drugs?

Doctors, others billing Medicare at higher rates (The Washington Post/Center for Public Integrity) - "Thousands of doctors and other medical professionals have billed Medicare for increasingly complicated and costly treatments over the past decade, adding $11 billion or more to their fees — and signaling a possible rise in medical billing abuse, according to an investigation by the Center for Public Integrity. Over the past decade, doctors have increasingly used higher-paying codes while cutting back on lower-paying codes Between 2001 and 2010, doctors increasingly moved to higher-paying codes for billing Medicare for office visits while cutting back on lower-paying ones, according to a year-long examination of about 362 million claims. In 2001, the two highest codes were listed on about 25 percent of the doctor-visit claims; in 2010, they were on 40 percent. Similarly, hospitals sharply stepped up the use of the highest codes for emergency room visits while cutting back on the lowest codes."

New cost control law expands role of physician assistants (The Boston Globe) - "Under the state’s new health care cost-control law, legislators are counting on physician assistants like Tuff as critical partners in the effort to curb medical spending, improve the coordination of treatment, and give patients easier access to basic care amid a shortage of primary care doctors. A little-known provision of the law, which Governor Deval Patrick signed in August, expands the role of physician assistants by requiring health plans to list them as primary care providers in directories and allow patients to choose a physician assistant as their provider. They still will work on teams with doctors, but they will have their own group of patients for whom they are primarily responsible. Nurse practitioners were given similar status in a 2008 state law."

Hospice For Harmon (GlassHospital blog) - "There was an unusual sports story in the news last week. Hall-of-fame slugger Harmon Killebrew announced that he’s ending his medical treatment for esophageal cancer, choosing instead to enter hospice care. As quoted in the NY Times piece, Killebrew wrote (via the Minnesota Twins’ press office), “I am very comfortable taking this next step and experiencing the compassionate care that hospice provides.” He said he had “exhausted all options with respect to controlling this awful disease.” This is the first time I can remember a celebrity declaring publicly a choice to stop medical treatment and pursue hospice."

Getting your prescriptions, without a prescription (The New York Times - Room For Debate) - "More Americans will have health coverage as the Affordable Care Act takes effect, which some analysts fear could lead to a shortage of physicians. One solution could be to eliminate unnecessary visits to the doctor, like for patients who just need a maintenance medication. Should more prescription drugs be made available over the counter? How should regulators decide which drugs to approve, and which to keep restricted?"