Categories

Tag: DRG Reimbursement

How to Cut Medicare Spending: Attack Large Claims!!

Medicare reform thus far has been focused on $79 office visits, co-payments for home health care, hospital readmissions, Miami infusion clinics, the price paid for scooters, $45 resting EKG’s, the Plan B deductible, etc. These are important areas to pursue — but they are not where the real money is.

While we are debating the ‘doc fix’, the drug companies, device companies and hospitals are backing up the truck and cleaning out the store!

Consider the following paid claims paid by Medicare in Indiana in 2011:

  • 113 Heart Transplants: average payment was $773,877 a piece
  • 96 Bone Marrow Transplants: average payout was $509,637 apiece
  • 129 Liver Transplants: average payout was $367,000 apiece
  • 2,200 Tracheostomies: average payout was $376,103 apiece
  • 1,517 Open Heart Surgeries: average payout was $185,000 apiece

Altogether, the 12,000 largest claims in one state totalled $2.4 billion in Medicare spending. If the other states are consistent, then large claims like these ate up $120 billion of Medicare’s total spending of $545 billion. And when you factor in sepsis treatments, defribillator-implants, and similar claims that cost “only” $75,000 each and so did not make the above list…….. then almost two-thirds of Medicare spending — over $300 billion a year — is focused on just ten percent of beneficiaries.

Continue reading…

Registration

Forgotten Password?