AUTHOR NAME
Tragedy strikes Cameroonian football
Why 5 Elementary Schools Had More Violence Than 17 High Schools In Same County (MuckReads Weekly)
Some of the best #MuckReads we read this week. Want to receive these by email? Sign up to get this briefing delivered to your inbox every weekend.
Violence spiked. No one responded. Now kids at five elementary schools are getting lessons in fear (Tampa Bay Times)
"It led me to believe that God didn't want my family in Florida." http://t.co/gRxQulisZ8 #FailureFactories
— Ron Brackett (@rontimes) August 21, 2015"On the day Salimah was hospitalized, there had already been more than 1,100 violent incidents at the schools in 2013-14. The experience left her mother, Tammy Bullock, so disturbed that she moved the family back to Philadelphia. She said she would rather take her chances in that city's public school system than remain in St. Petersburg. 'I've never seen anything like this in my whole life," Bullock said of Campbell Park. 'It led me to believe that God didn't want my family in Florida.'"
Ticket to nowhere: The hidden cost of driver's license suspensions (The Milwaukee Journal Sentinel)
Traffic racket? When not paying ticket brings 2x penalty of hit-and-run injury: http://t.co/3m5H2mI7bb #muckreads pic.twitter.com/LNA2cdL26W
— Amanda Zamora (@amzam) August 18, 2015"Without valid driver's licenses, they lose job opportunities and fall deeper into financial straits. Some even end up in jail — a cost to the community — for not paying their traffic fines. In an already deeply segregated city, a disproportionate number of those affected are minorities. Ultimately, the city may just erase the debt, never collecting on its money at all."
Second-chance cops: 'My son wouldn't be dead if they hadn't hired him' (The Denver Post)
Second-chance cops become issue in Rocky Ford after fatal shooting: http://t.co/Q8VFI5xQNi via @chrisosher #muckreads
— Greg Griffin (@GregGriffin) August 17, 2015"At least four of Rocky Ford's 10 officers have had problems in previous law-enforcement jobs or had criminal convictions that might have kept them from being hired at bigger departments or in other states, The Denver Post found. ... 'Any larger enlightened agency does a thorough background investigation,' said the former police chief in Aurora. 'But smaller agencies in smaller states like Colorado don't have robust investigations. They might not even check with a prior employer.'"
A tale of two New Orleans (BuzzFeed News)
the Crescent City is at risk of losing something much more valuable than what it has gained. http://t.co/wKt9i1i42l
— One Voice Radio (@OneVoiceRadio) August 20, 2015"...while in most cities gentrification is caused by a simple desire for prime real estate, in New Orleans the draw is the very culture that the resulting changes to the city is eroding. Like many natives of the city, Domonique Meyers thinks New Orleans is already in danger: 'It's 'bout to be extinct.'"
Sons of indicted Swiss financial adviser keep business in the family (Bloomberg Business)
My exclusive: How indicted Swiss adviser's offshore business stayed in the family; he's still a fugitive: http://t.co/yyXOnSspFK #muckreads
— Jesse Drucker (@JesseDrucker) August 19, 2015"'People are indicted all the time,' said Dustin Milne, the Zurich attorney representing [Josef] Beck's company, Beck Verwaltungen AG, and his sons' firm, which manages $22.7 million for a handful of mostly wealthy Americans in New York and Florida, according to an SEC filing. 'Should the family stop being interested in running the family business? Should they stop looking for opportunities that they heard about at the dinner table?'"
Unused oil and gas gear threatens habitat, drinking water (E&E Publishing)
Slew of abandoned oil and gas wells threaten water and wildlife on federally protected land #muckreads @CorbinHiar: http://t.co/XpvBC0Bz4n
— Jennifer Gollan (@jennifergollan) August 19, 2015"'Orphaned wells can pose environmental hazards because hydrocarbons, salts and groundwater mingle,' the OIG said. ... Surface seepage is a particular problem because it can harm humans and wildlife as well as 'increase the risk and ferocity of wildfires by providing hydrocarbons as additional fuel,' the OIG added. The agency estimated in a May fact sheet that there are 450 unplugged oil and gas wells throughout the system that no longer have a known or solvent operator. Completely cleaning up those orphaned sites could cost taxpayers in excess of $20 million."
Treatment Tracker
We’ve updated our database of Medicare’s payments to individual doctors and other health professionals serving the 49 million seniors and disabled in its Part B program.
Patient Guide
When choosing a doctor who's right for you, you don't have to rely exclusively on a friend's recommendation or a referral. You can check whether your medical provider practices similarly to his or her peers.
ProPublica's Treatment Tracker tool allows consumers to compare their doctors, physical therapists and other health providers to others based on data on the services they provide in Medicare's Part B program.
The tool may give you, the patient, information to ask important questions about your care. Here's what to look for and ask:
- Does your doctor perform more services and order more tests per patient than others in his or her specialty and state? Along the same lines, is your doctor's cost per patient higher than peers? If your doctor is in the top 10 percent, you'll see a note in red. It may be worth asking questions to ensure you are not being over-treated. More health care does not always equate to better health care.
- Are the most common services and treatments chosen by your doctor similar to others in the same specialty and state? Some doctors may be relying on unconventional or even questionable therapies that their peers do not. You may want to look for large gaps between where a service ranks for your doctor and where it ranks among similar providers. You'll see an orange symbol in our app if one of a doctor's services has been performed by five or fewer providers in his or her specialty and state.
- Are there drawbacks to the tests your doctor orders? Radiation exposure carries risks, and screening tests may turn up false positives or abnormalities that may not actually be health problems, such as a precancerous node that won't develop into cancer. In addition, tests may add unnecessarily to your costs, via your co-pay, and to those of the government. It's worth asking whether medical tests are necessary, especially if you have recently had similar tests.
- If you need a procedure, say a knee replacement or cardiac stent, does your doctor have much experience performing it? While this data only includes Medicare patients, it's one indicator of how practiced a physician might be at performing a procedure. Studies show that doctors with more experience generally have better outcomes.
Your doctors may not know that they are practicing differently than their peers. If nothing else, your questions may prompt them to look at the data or discuss their approach to medicine. Additional research on reputable health websites such as mayoclinic.org may also help.
Other tools may allow you to learn even more about your provider.
- Does your physician accept payments from pharmaceutical companies or medical device makers for promotional work? Checking our Dollars for Docs app may provide the answer. If your doctor has a relationship with a company whose product he or she is prescribing or using, you may want to ask about whether that affects decisions.
- How do your doctor's drug prescribing patterns compare to peers? With our Prescriber Checkup tool, you can see if your doctor prescribes more narcotics, antipsychotics or risky drugs in Medicare's Part D program than colleagues, or whether he or she favors brand name drugs over generic medications.
- If your doctor is a surgeon, how does his or her complication rate compare to peers? You can use our Surgeon Scorecard to compare differences on eight common elective procedures, including knee and hip replacements.
- Does your health provider have discipline against his or her professional license? Each state has licensing boards that oversee health professionals and sanction providers for misconduct. Links to medical boards are available on our provider pages. If your provider has faced discipline, it's worth seeking out the details (sometimes they are online, sometimes you have to call or write the board) and determining if the provider is the right match for you.
Treatment Tracker Methodology
Updated: August 2015
The Centers for Medicare and Medicaid Services released data in June 2015 on the treatments performed by, and the payments made to, health care professionals who cared for beneficiaries in Medicare's Part B program in the year 2013. (The agency first released this data, covering the year 2012, in 2014.) The data covers more than 950,000 health care providers who collectively received $90 billion in Medicare payments.
Part B covers the services delivered to seniors and the disabled by doctors, optometrists, physical therapists and other practitioners. The program also covers ambulance mileage, lab tests, outpatient services and drugs administered by doctors.
We created an interactive news application called Treatment Tracker that places this newly released data in context, showing how providers compare to their peers — that is, providers in the same state and specialty — in terms of the services they perform.
Treatment Tracker includes pages for every health professional, state, medical specialty and service billed to Medicare.
It relies primarily on two files provided by CMS:
- A summary table of the total number of patients treated by each provider in Medicare's Part B program in 2013 and the total amount paid, among other things.
- A detailed list of the services performed by each provider in Part B in 2013, including the number of patients treated, the number of times the service was performed, and the number of unique patient visits during which each service was performed (some services, such as drug infusions and skin tag removals, may be billed multiple times during a single visit). The table also differentiates between medical services and drugs. Medicare has published a detailed methodology online for how it has gathered this data. The data is also available for download online.
Two important caveats: Medicare only released data on services and referral patterns if they applied to at least 11 patients. If a service was performed on 10 or fewer patients, CMS redacted it and excluded it from aggregate totals.
Also, the data does not include Medicare Advantage plans, which are the health plans Medicare beneficiaries can choose in place of the traditional program. Nor does it include services delivered to patients with other coverage, such as private health insurance or Medicaid.
At the top of each provider's page, ProPublica displays summary information, including the total number of patients that provider treated in Part B in 2013, total services/procedures performed, and the total paid by Medicare. In addition, we show the average number of services delivered per patient by the provider and the average Medicare reimbursement per patient, as well as comparisons to peers in his or her specialty and state. If a provider performs more services or spends more per patient than 90 percent of peers, a note will appear in red.
We note situations in which a significant share of a doctor's Medicare payments comes from drugs they administer (because much of the reimbursement is intended to cover the cost of the drugs themselves).
If a provider had more than 100 office visits for established patients (those he or she has seen at least once before), we also have a graphic breakdown comparing those visits to peers. Such visits are coded on a scale of 1 to 5 (actually 99211 to 99215, with 99215 being the most complicated, using procedure codes created by the American Medical Association).
Nationally, a very small percentage of visits are labeled 99215, but Medicare and its inspector general have raised concerns about upcoding, or billing for higher-level services than are actually delivered, by some providers. Also see our story and accompanying methodology on this topic.
Just because a provider has a higher proportion of complex visits than peers is not necessarily an indication of a problem, but it may be worth asking about.
Lower on the page, we show how each service ranks among that provider's services and compare that to its rank among others in his or her specialty and state. We include:
- The code number for the service and a description, as well as whether it was performed in an office or a facility such as a hospital. In most cases, the office-based services are reimbursed differently than those delivered in a facility, and are broken out separately by Medicare.
- Whether the code is for a medical service or a drug. As mentioned above, much of the Medicare reimbursements for drugs is intended to cover the cost of the drugs themselves.
- The services listed come from two places. Services that begin with a letter come from CMS. All other codes and descriptions of the medical procedures are from the Current Procedural Terminology code set, which was created and copyrighted by the American Medical Association and is used here with the AMA's permission. Where practical, we used the AMA's consumer-friendly translation of the CPT descriptor.
- The number of times each service was performed, or units delivered, and the percentage of all of the services provided that represents. Some services, such as drug infusions (e.g., per milligram, per unit, etc.), ambulance trips (per mile) and skin tag removals are meant to be billed multiple times during a single visit.
- This service's frequency rank for this provider and also how it ranks among all those in the same specialty and state. If a service has been performed by fewer than five providers in the specialty and state, you will see an orange symbol. Though this in isolation does not necessarily indicate there's a problem, if your doctor performs a service that so few of his or her peers perform it may be worth asking for additional information about why that's the case.
- The number of the provider's patients who received the service at least once during 2013, and what percentage of all of the provider's Part B patients that number represents.
- The average number of visits that patients made to receive this service. This is calculated by using a field in the data that totals distinct visits on separate days for this service. Since a beneficiary may receive multiple services of the same type (e.g., single vs. multiple cardiac stents) on a single day, "this metric removes double-counting from the line service count to identify whether a unique service occurred," Medicare says.
- We took this figure (which is not shown) and divided it by the number of patients who received the service to arrive at the average number of unique visits per patient. For comparison, we show the average unique visits for this service for all providers in the specialty and state who delivered the service on at least 11 patients.
- The total amount billed to Medicare and the average amount paid by Medicare. These take the average payment per procedure billed and paid, provided by Medicare, and multiply it by the service count. Services performed at a facility appear to cost Medicare less than office-based services because a separate facility fee is not disclosed in this file.
More broadly, we do not include any comparative information when there are fewer than 11 of that kind of specialist in the state. We also do not compare providers if they have moved to a different state between 2013 (the period covered by the data) and 2015. We also do not compare providers to their peers if they have not designated a primary specialty in the National Provider Identifier system.
We used demographic information, including addresses, phone numbers and primary specialties, from the NPI system, as of July 2015.
Below are the limitations on the data CMS has listed on its website:
- It only describes care delivered to Medicare beneficiaries in the fee-for-service program and, as a result, may not represent a provider's entire practice. Providers may also see patients enrolled in Medicare Advantage, those with Medicaid coverage or private health insurance, or those who are uninsured.
- It does not provide any information on the quality of care delivered by providers.
- It does not account for differences in the sickness of patients treated by different providers.
- Medicare pays differently when services are provided in a physician's office versus a facility (e.g., a hospital outpatient department). For services furnished in an office setting, the full payment is included. However, if a service or procedure was furnished in a facility setting, in most cases, this data only includes the payment to the provider and not the payment to the facility.
- In general, when a provider administers drugs to a patient, the provider purchases the drug and Medicare pays the provider 106 percent of the average sales price (ASP) for the drug.
- The way CMS counts services may differ by billing code. For example, if the number of services is 2 this may reflect two separate procedures, two 15 minute increments of a service (e.g., a 30 minute office visit), or the delivery of two units of a drug.
Do you see an error in this data?
If you are a provider and you believe your address is wrong, you can change it on the website of the National Plan & Provider Enumeration System. If you believe the procedure data is incorrect or have other questions, you can email CMS at MedicareProviderData@cms.hhs.gov. You can also contact us at checkup@propublica.org.
