3 ms·
This is a really cool tool: http://projects.wsj.com/medicarebilling/ http://projects.wsj.com/medicarebilling/ Does anyone here know much about Ophthalmology?
by vinhboy 13y ago
This is a really cool tool:
http://projects.wsj.com/medicarebilling/ http://projects.wsj.com/medicarebilling/
Does anyone here know much about Ophthalmology?
What is a "Ranibizumab injection"? It's making bank!
The top guy does 37,075 of these are year, at $320 a pop.
That's about 100 a day....
- rememb1 13y agohttp://en.wikipedia.org/wiki/Bevacizumab#Uses_in_eye_disease http://en.wikipedia.org/wiki/Bevacizumab#Uses_in_eye_disease Probably why there is a lot of controversy surrounding this and the price of this drug.
- riahi 13y agoRanibizumab is the generic name of Lucentis, an injection into the eye that is used to treat age-related-macular-degeneration. The way Medicare works is that Lucentis is pre-purchased by the ophthalmologist and then reimbursed by Medicare. The doctor is taking home only a fraction of that reimbursement, as the majority of that reimbursement is going directly to the manufacturer. I posted this elsewhere, but the way Medicare for these high-reimbursement specialties (Ophthalmology, Radiation Oncology, and Medical Oncology) is that the Doctor's practice will pre-purchase the medications/injections/treatments before administering to patients and then Medicare will reimburse the practice. These doctors are certainly not taking home anywhere near a fraction of that number. See: http://oig.hhs.gov/oei/reports/oei-03-10-00360.pdf http://oig.hhs.gov/oei/reports/oei-03-10-00360.pdf
- vinhboy 13y agoOk. That makes sense. I'll put away my pitchfork. But a follow up question. Why are some offices doing so many of these? 100/day. That's like a Ranibizumab assembly line.
- vinceguidry 13y agoThe article states that many of the offices getting the largest reimbursements have all of their billings going through one doc. So a large-ish ophthalmology clinic with fifteen eye docs looks like one doc according to the data.
- HillRat 13y agoThe standard treatment protocol is monthly injections on an indefinite schedule; given the prevalence of age-related macular degeneration, it's easy to see how a clinic in a high-retirement area could profitably optimize to do hundreds of these. Lasik clinics operate on a similar principle. (I'll spare you my argument that medicine is basically the last outpost of the Marxian labor theory of value, but suffice it to say that when capital investments in an industry don't improve profit, then Taylorist labor optimizations will step in to fill the void.) riahi might be able to answer this -- any idea what the cost is of ranibizumab these days? A single injection used to run about $2K, but I don't know what the price is now.
- riahi 13y agoYes. If you download the April ASP data from CMS [1], you can search for "Ranibizumab injection". CMS has calculated a $397.014 payment per 0.1 mg. Each dose injection is 0.5 mg, so 5 * 397.014 = $1985.07. If you add 6% to that, you get $2104.17. Your memory was correct. 1: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/2014ASPFiles.html http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-...
- maxerickson 13y agoOne fairly likely possibility is that he is billing for other doctors: http://www.melgeneyecenter.com/index.html http://www.melgeneyecenter.com/index.html
- riahi 13y agoHe's actually being investigated for fraud. So if we take him out of the picture, the remaining numbers make sense.