by Gail Kalinoski
, Contributing Reporter | August 15, 2016
New medical devices that can be used for testing in doctors’ offices are boosting Medicare spending for certain services by millions of dollars, as more physicians use the equipment themselves rather than refer patients to specialists, according to a Wall Street Journal report.
The WSJ report found that four of 10 Medicare services that had the fastest-growing payments from 2012 through 2014 used medical devices in doctors’ offices. One test in particular, a sweat-scanning test used to detect autonomic neuropathy often found in diabetic patients, saw a $16.7 million increase in payouts, or a 10-fold increase, according to the Journal’s analysis.
One New Jersey doctor, who said he uses it in his practice as well as at health fairs around the state, received $105,905 in Medicare payments in 2014 for providing services with the sweat-scanning device. The doctor defended use of the device noting it is helpful to show patients results of a test so that they will be more inclined to follow up.
The sweat-scanning test is one of four services that the Wall Street Journal found had pushed Medicare spending by $123.5 million during the two-year period, to payments of $135 million. It notes that while that amount is small compared to Medicare’s annual $6 billion budget, increases like those can be what the WSJ called a “driver of runaway health costs.”
The Journal also found that a fairly small number of physicians had begun using the medical devices in their offices, noting that “less than 10 percent of doctors accounted for more than half the rise in spending for each service.” The newspaper stated it only analyzed services during the period that received at least $5 million in 2014 Medicare reimbursements.
Another test that is increasingly being done in doctor’s offices is one to measure the amount of salt in tears. The WSJ said it was one of the top 10 fastest-growing services, with the highest billings during the time period studied. Introduced in 2012 by one manufacturer, eye doctors can now use the test on their patients in the office and bill Medicare for its use. The WSJ found about 3,000 doctors – mainly ophthalmologists and optometrists – received $14.8 million in 2014 from Medicare for the tests, an increase of $1.75 million from 2012 when Medicare first started covering it.
One Brooklyn ophthalmologist interviewed for the story got $130,795 in Medicare payments in 2014. He reportedly tested 84 percent of his patients compared to a median of about 11 percent of other doctors during the same time period. The doctor told the WSJ that more patients complain of dry-eye ailments because of increased use of contact lenses and more screen time.
Another medical device with increased in-house use by physicians that was cited in the report is electronic brachytherapy, or EBT. It was initially mainly used for breast cancer treatment but dermatologists later found it to be helpful for treating some non-melanoma skin cancers.
The WSJ report stated Medicare paid $95 million in 2014 for EBT services, up from just $7.8 million in 2012. Most of the payments were for skin cancer treatments.
A San Diego dermatology practice was cited in the story as receiving $4.6 million for EBT treatments in 2014, accounting for about 83 percent of all the practice’s Medicare reimbursements. The doctors didn’t use EBT at all in their practice in 2012, according to the WSJ.
A Medicare spokesman told the newspaper that it monitors spending on services so, “We can correct [billing] codes that may be misvalued and identify possible improper payment without limiting patient access to new important therapies.