Feds say area ‘potentially overserved’
By MAUREEN GROPPE news-press.com Washington Bureau and JANINE ZEITLIN
jzeitlin@news-press.com
Above-average billing for doctors’ services for Medicare patients in Fort Myers and other parts of the country could be an example of how there’s waste to cut in the system, according to a new government report.
The Fort Myers-Cape Coral area was one of 72 areas that the Government Accountability Office has identified as “potentially overserved,” meaning Medicare patients got more doctor services than seniors in other areas of the country, though demographics didn’t indicate they had more health risks.
“Some of the higher volume and intensity that drive spending growth may not be medically necessary,” the report said. “Physicians have a financial incentive to perform as many services as possible because Medicare pays them a fee for each service provided, with little accountability for quality or efficiency.”
But Fort Myers area doctors said it was more likely any extra use of services locally was more driven by better access to care, patient requests and changes asked by drug companies that require additional office visits.
“It may be just be that this is an area where a lot of specialists and doctors come,” said Dr. Lee Adkins of Fort Myers Family Medicine. “These procedures are done only when indicated or Medicare wouldn’t pay for them.”
About half of his patients are on Medicare. Adkins was dismayed by the findings and noted that Medicare is his lowest payer among any other insurance plans.
In Florida, every area in the state except Daytona Beach and Tallahassee was labeled “potentially overserved.”
Services per beneficiary in the Fort Myers-Cape Coral area grew 26 percent from 2000 to 2008, compared with 14 percent nationwide. Services per beneficiary in the Naples area grew 19 percent.
The report found that potentially overserved areas tend to be more populated and in the eastern part of the nation.
Local Medicare beneficiaries don’t feel like they are getting too many services.
“I personally cannot believe that we are being given anything in terms of Medicare benefits that other Medicare beneficiaries are not receiving,” said Bobbi Brown, a 72-year-old south Fort Myers resident.
She wonders if the large number of people on Medicare here may skew the numbers.
“When you get on Medicare, where are you going to go to have great weather year-round? Fort Myers, Florida,” Brown said.
‘Patient-driven’
Dr. Raymond Kordonowy of Internal Medicine of Southwest Florida in Fort Myers said many other physicians advertise services, which patients then request.
“Maybe this is patient-driven as opposed to the innuendo that doctors are behind this,” Kordonowy said.
He also noted that prescription plans ask that he prescribe different drugs for patients to lower costs, which then requires an additional evaluation.
Hospitals may also consult a myriad of specialists for a patient for efficiency and liability fear, Kordonowy said, in explaining possible overservice in this region.
Officials at Lee Memorial Health System, which runs local hospitals, did not respond to requests for comment on the findings.
Dr. J. James Rohack, president of the American Medical Association, said the medical profession is committed to addressing variations in care, but that high growth in services doesn’t always equal overuse.
For example, Rohack said, some services being used more often — such as colonoscopies and office visits — are encouraged by Medicare to promote early detection, prevent disease and manage chronic conditions.
“GAO’s analysis confirms that the issue is far too complex for simple solutions like redistributing funds from low-spending to high-spending areas, and that the most successful interventions will be locally based,” Rohack said.
Cutting waste
The GAO, the investigative arm of Congress, looked at how many physician services per patient were billed to the government from 2000 through 2008 — as well as the growth in services per patient — in 296 areas. Areas that rank in the top half in both categories are considered “potentially overserved.”
The health care overhaul proposals in Congress include provisions aimed at changing how Medicare is delivered so doctors are rewarded more for quality of care, not just quantity.
Reform advocates contend that plenty of waste and inefficiency can be cut from Medicare without reducing quality of care.
“The potential abuse and excessive spending revealed in this report is further evidence the status quo of rising health care costs is unacceptable for America’s seniors and the long-term fiscal health of the Medicare program,” said Sen. Max Baucus, the Montana Democrat leading the effort to craft a Senate health care bill.
Fort Myers resident, Marlene Cascio, 72, worries that attention to usage in the report might impact her Medicare benefits.
“I don’t know why they would want to make us miserable. I’m scared.”
Cascio said she has refused suggested tests such as a colonoscopy, but she still thinks they are necessary prevention.
“It’s a precaution. Especially for Medicare people, the doctors are not getting a lot of money.”
