By Lisa Aliferis
Tue, May 20 2014
By April Dembosky
By Lisa Pickoff-White
When people think of seeing a doctor, generally the first thing that comes to mind is an office visit. But not all visits are the same. Frequently, patients have minor problems, which can be dispensed with quickly. Other problems are much more complex and require more of a doctor’s time and expertise. Not surprisingly, doctors get paid more for these more complex visits. Office visits for established patients are billed across five levels.
Three California doctors are among the top five nationally in billing for the most complex office visits, according to data released by Medicare and analyzed by ProPublica and KQED.
Most doctors’ billing patterns to the Medicare program fall in the middle ground between simple and complex.
In California, only 5 percent of doctors’ office visits for Medicare patients were billed at the highest level in 2012. It is unusual for doctors to determine — and bill — a large proportion of their office visits as complex.
The analysis of Medicare billing data — which was made public for the first time last month — shows that three California doctors are among the top five nationally in billing for the highest number of the most complex office visits. In addition, they tended to bill at the highest level significantly more frequently than peers in their specialty.
-- In Orange County, Dr. Louis VanderMolen, a hematologist-oncologist, billed Medicare for 6,340 of these visits in 2012, the most of any doctor in the country and significantly more frequently than similar specialists nationwide. Almost 79 percent of his office visits were billed at the highest level, whereas other hematologist-oncologists only billed 12 percent of their office visits the same way.
-- In the Santa Cruz County community of Freedom nearly every one of cardiologist Jeffrey Mace‘s patients received – and was charged for – the highest complexity visit. Mace billed Medicare for these high level visits almost 10 times more often than other cardiologists in California, and the third most in the country
-- Cardiologist Jay Schapira ranks fifth in the country for the number of times he billed the most complex type of visit to his office in Los Angeles. His average patient received four of these visits in a year, compared to the one visit typical of other cardiologists in the state.
“That’s unusual for a doctor who’s not seeing patients in the hospital,” said Lamar Blount, a Medicare billing expert with the Health Law Network consultancy in Atlanta. “Usually cardiac patients in the hospital are the ones that are about to die.”
KQED conducted this analysis in conjunction with ProPublica, which published a national investigation last week. ProPublica also developed a “Treatment Tracker” tool, which allows consumers and journalists to look up a provider and see how often he or she bills at the highest level for office visits.