Wednesday, April 9, 2014

New York Times to Medicare: You Furnish Me the Pictures. I Will Furnish You the Scandal!

Some years ago, an endocrinologist in Providence, Rhode Island awoke to his morning paper to see his name plastered across the front page: He had collected over $4 million dollars from Medicare the previous year. What a scoundrel! How could he have possibly done enough service to justify such an enormous amount? (In today's dollars that would be about $20 million.)

The endocrinologist happened to be  the Chief of Medicine at Rhode Island Hospital, and all the billing for every intern, resident and for some attendings were billed under his Medicare number. Of course, he did not get a dime of it. He was on salary. The money went to the hospital and to Brown University School of Medicine.

This morning, something similar may have happened to some ophthalmologist in Florida, who found he led all doctors in Medicare payments at $21 million dollars.  Maybe this guy is a scoundrel, but maybe he is injecting a lot of intra occular medicine (Lucentis)  at $2,000 a pop,  to prevent blindness in his patients. Maybe he is paying $2,000 for that medicine and Medicare is reimbursing him. I don't know. I'm just saying. There are all sorts of accounting quirks in any insurance bureaucracy. 

There are other wrinkles in this story: a drug called "avastin" may work as well as Lucentis, and costs only $150 a pop, but the manufacturer and the FDA would have to agree to allow this treatment. Lucentis has gone through the process of proving efficacy and safety. Avastin would have to do the same. But the $21 million dollar opthalmologist would not be in control of any of that.  If the opthalmologist, or his associates did 10,000 injections a year, or 5,000 patients a year or 14 patients a day, that would account for that staggering $21 million. But we do not know, because the New York Times did not do the basic journalism. They did not get answers to the basic questions.

The trouble is, nowhere in the New York Times front page, lead article, above the fold article is there an analysis of exactly what was going on with this $21 million pay out. They clearly just got the number and ran the story, the way, say, The Daily News would have done. Why ruin a great headline with a detailed analysis?

William Randolph Hearst  once sent Frederick Remington  to Havana to gets pictures of Havana in  the coming war with the Spanish. Remington wired Hearst, saying there was no war. "You furnish me the pictures and I will furnish you the war." This newspaper tradition of fanning the flames goes all the way back to Hearst. The New York Times, as great a newspaper as it is, or once was, is not above that tradition.

This all comes at a time when the US Congress has, once again, decided to simply renew Medicare funding for a single year rather than for 5 years, which is what hospitals and doctors' groups want so they can plan ahead. But when the Congressmen and Senators read this headline they are going to think no deeper and they will say, "Well, good thing we didn't give those hospitals and doctors what they wanted--we would have allowed these doctors to rape the system for 5 years. Next year, we can go get those scoundrels."

The system we have is a commercial system. It is based on profit and the game, one might say, is to maximize profit. Maybe the $21 million dollar ophthalmologist just learned how to play Liar's Poker better than everyone else.  He may say, "Hey, I didn't make the rules. I just played the game."

Maybe we ought to think more about the game. Maybe it shouldn't be a game. Maybe we should devise a system which can't be gamed, because it's not about profit, but about service.

Oh, but there I go again. Politically incorrect. 

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