Medicare Records Provide Tantalizing New Details Of Payments To Doctors

Washington, DC, United States (KaiserHealth) – Medicare’s release Wednesday of millions of records of payments made to the nation’s doctors comes as the government is looking to find more cost-efficient ways to pay physicians, particularly specialists.

The federal government published data tracing the $77 billion that Medicare paid to physicians, drug testing companies and other medical practitioners throughout 2012, and what services they were being reimbursed for.

The data cover 888,000 different practitioners. More than 6,000 procedures are included, and the full database is so large that it requires statistical software to analyze it. While the database provides tantalizing details, showing for instance the huge amount ophthalmologists are paid to treat a common eye disorder, experts cautioned that the data can be easily misunderstood and could lead to some doctors’ incomes being unfairly pilloried.

The release comes 35 years after a court-issued gag order that prevented anyone from revealing Medicare Part B payments to individual doctors, and advocates for more transparency in health care payments heralded the release as a leap forward. “Taxpayers have the right to understand what is being paid for and how it is being paid for,” said Jonathan Blum, principal deputy administrator for the Centers for Medicare & Medicare Services.

He asked for the public to comb through the information to help find waste and fraud and also encouraged researchers to use it to try to determine why spending on health care for the elderly varies so much in different parts of the country. This could replicate on the physician level what the Dartmouth Atlas of Health Care has been doing for decades in showing variances in Medicare’s hospital spending.

“The uses of this data can and will go significantly beyond the identification of fraud, waste and abuse,” said Niall Brennan, the Medicare official who oversaw the development of the database.

The release also comes at a propitious time for the government’s effort to refashion the way America’s health care system is financed. Earlier this year Medicare invited advice on how it should devise new ways of paying specialists to replace the current system, in which doctors are paid a set fee for each visit or procedure. The goal of these approaches is to remove the financial incentive for practitioners to do more services.

Under the authority of the federal health care law, the Obama administration has already launched experimental programs aimed mostly at hospitals and large medical groups. There are hundreds of trial efforts under way to pay medical practitioners a set fee to treat a defined ailment, such as replacing a knee, with the fee covering all aspects of the care from before the operation through the recovery and any setbacks.

Medicare is in the midst of creating a similar program for cancer specialists. In February, the government’s Center for Medicare & Medicaid Innovation invited suggestions on how it should fashion new payment programs that “would be designed to improve the effectiveness and efficiency of specialty care, in part by clarifying the specialist practitioner’s clinical role.” The deadline for ideas and suggestions is Thursday.

Dr. Kavita Patel, a former White House health care expert and a researcher at the Brookings Institution, a Washington-based think tank, said the administration’s timing was not coincidental. “They are building the case for doing targeted specialty payment models,” she said. “The administration is trying to get at the delivery system from all angles.”

Unsurprisingly, medical specialties that rely on expensive drugs, such as oncologists and ophthalmologists, appeared at the top of the list of biggest reimbursements. That’s because in 2012 Medicare pays doctors for the market cost of drugs they use plus 6 percent, Blum said. (That amount has been lowered by the spending cuts imposed by Congress, known as the sequester.)

What’s Missing

Despite their size, the Medicare records omit as much important information as they include. The records do not include any treatments doctors do on non-Medicare patients, such as people on private insurance, Medicaid and those who pay cash. The records also lack any information about roughly a quarter of Medicare beneficiaries who have coverage through Medicare Advantage private insurance plans, and for various experimental payment reforms the government has initiated. The payments for some doctors may be larger than it appears in the data because they also could have billed Medicare through a combined medical practice or other medical organization.

Fred Trotter, a heath care data expert pre-emptively warned reporters and analysts that: “We should be very careful to not draw any conclusions at the low end of the spectrum. That doctor who ‘only’ performed procedure X eleven times? That probably means nothing. What the doctor is actually doing with his/her patients is just not showing up at all.”

Procedures billed to one doctor may actually have been performed by a number of workers in one practice such as medical residents, nurses and physician assistants. A Los Angeles rheumatologist who Medicare paid $5.4 million in 2012 told The Washington Post that about $5 million of that paid for very expensive drugs and the billings also helped cover his staff of 40 people. CMS’ Brennan said that one goal of the release was to encourage each individual medical practitioner to bill Medicare directly, so that the government could get a better handle on spending.

In a note published on the website of the Association of Health Care Journalists, Charles Ornstein, a senior reporter at the investigative nonprofit Pro Publica, cautioned reporters to be careful in interpretation, writing: “Don’t just assume that because a number is large, a doctor has done something wrong.”

In addition, there’s no information about the quality of the care provided, and no information about how sick the patients were or why a particular procedure was performed. In fact, to ensure that the identity of any patient could not be known, Medicare has only included procedures that each doctor performed at least 11 times.

Large numbers of procedures performed by a doctor may be a good sign. Someone billing a lot might well be a very talented practitioner, since research has found that medical skill tends to improve the more times a physician performs the same operation.

In fact, health care experts often encourage patients to choose a doctor based on the volume of cases the physician has done. Alternatively, in some cases—probably a small number—a doctor with lots of billing could be ripping off the system. Several doctors with the biggest Medicare payments are already under investigation for potential fraud, such a Dr. Salomon Melgen, a Florida ophthamologist who The New York Times said was paid $21 million in 2012. His lawyer said Melgen has followed all Medicare rules.

The back story of the gag order on this data stretches back to’79, when a Florida court issued a permanent injunction barring the government from releasing information about Medicare payments to individual physicians in any manner that would allow the doctor to be identified. In 2011, the parent company of The Wall Street Journal successfully sued to overturn the injunction as the paper prepared a detailed look at Medicare spending.

The American Medical Association complained that physicians were not allowed to review the data for inaccuracies. However, Medicare’s previous release of similar information about hospital payments did not result in reports of any major errors. Brennan pointed out that the data is based on claims medical providers billed to Medicare and were reimbursed for. “We are quite confident this data is accurate,” Brennan said.

Where Can I Find The Data?

If you just want to look up a specific doctors or a few dozen in an area, both the Wall Street Journal and The New York Times have handy interactive look-up tools.

Medicare has published the data files here. Medicare has also put out a technical overview of its methods.

– Provided by Kaiser Health News.

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Icon Shoes to feature Margaret Keane art for Spring 2015 collection

Windsor Genova – Fourth Estate Cooperative Contributor

Palm Desert, CA, United States (4E) – Icon Shoes, which introduced art-printed leather shoes in 1999, will have a work of American painter Margaret Keane printed on its upcoming shoes and handbags.

The original producer of “walking works of art” by having Andy Warhol’s Campbell Soup Can imprinted on leather sneakers is letting women all over the world to choose one of two arts by Keane through a Facebook voting contest. In the Facebook page “Icon Curators Contest” (, Icon Shoes ( will gather votes for the painting called “Ladies In Waiting” and “A happy day in paradise” to select which one of the Keane arts will be used as a design for the fashion house’s Spring 2015 Collection. The art with the most votes will be the print in the company’s upcoming shoes.

Since launching its Andy Warhol Campbell Soup Sneaker, Icon has become a leader in designing and manufacturing luxurious, high-quality, high-fashion shoes, handbags, and accessories. It is Icon’s goal to create leather goods that make people feel fashionable and comfortable while bringing art to the world in an innovative way.

“Icon recognized early that beautiful art is great to wear as well as collect. The finest art, the finest materials, the finest craftsmanship make ICON a true collector’s dream,” according to the company’s website,

With a keen eye to trending colors and textures, Icon’s talented designers and graphic artists skillfully select and reproduce classic and contemporary artwork onto its leather products. They are exacting in their attention to detail to ensure that the images are sized and positioned to complement each product type, while maintaining the integrity of the artwork they interpret. Icon’s patented printing process transfers the exclusive, licensed artwork onto high-quality leather.

Icon works closely with up-and-coming artists and their representatives, supporting them through royalties paid from every purchase of their product. This groundbreaking idea to imprint colorful and classic pieces of art into leather shoes revolutionized the world of footwear.

By using the art of talented emerging artists, as well as the masters such as Monet, Van Gogh and Klimt, Icon quickly caught the attention of celebrities, media, popular retailers, and fashion-savvy women worldwide. Icon is now a leader in luxurious shoes as well as a trendsetter in handbags and small leather goods.

Icon takes pride in producing stunning “wearable works of art” that express a woman’s individuality through function and style. The arts are from classic painters such as Alberto Vargas, Alphonse Mucha, Amedeo Modigliani, Andy Warhol, Cécile Hubené, Claude Monet, David Delamare, Edgar Degas, Édouard Manet, Frederick Leighton, Gustav Klimt, Henri de Toulouse-Lautrec, Henri Matisse, Jan Vermeer, Jim Zuckerman, Joan Miro, John William Waterhouse, Ken Done, Kitagawa Utamaro, Nelson De La Nuez, Pablo Picasso, Paul Cézanne, Paul Gauguin, Paul Klee, Pierre-Auguste Renoir, Rex White, Rodney White, and Vincent Van Gogh.

The company went on to say, “Today, a woman needs to feel unique and special, expressing her own individuality. When she chooses the artwork that appeals to her from her Icon collection she makes a statement about who she is and her unique look at life. She shows the world her individual style and starts a conversation every time.

Icon is based in a beautiful showroom, displaying original works of art, in Palm Desert, California. Its products can be found at select boutiques and department stores in the U.S. and Canada, as well as on their website,

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Urban Outfitters Inc. posts $88.7M profit in Q4

Nathan Andrada – Fourth Estate Cooperative Contributor

New York, NY, United States (4E) – Urban Outfitters Inc. reported a 7.4 percent rise in fiscal fourth-quarter profit, due to increase in sales, though problems persist for the company’s namesake brand prompting the retailer to provide a light warning about its performance for the current quarter.

Profit was at $88.7mn, or 59 cents per share, for the quarter ended Jan. 31, compared with $82.5mn, or 56 cents a share, in the previous year.

The company reported in February that fourth-quarter sales rose 5.7 percent to $905.9mn.

Gross margin slightly increased to 36.7 percent from 36.6 percent, helped by sharp improvement in the markdown rate of the company’s Anthropologie brand. The positive performance was mostly offset by higher markdowns at the company’s namesake brand.

Comparable retail sales, which include those in the company’s catalog and online businesses, gained 1 percent in the fourth-quarter. Same-store sales rose 10 percent at Anthropologie and surged 20 percent at Free People, but declined 9 percent at the Urban Outfitters brand.

Teen-focused retailers are faced with intensifying competition from fast-fashion players such as H&M Hennes & Mauritz AB and Forever 21 Inc., hurting sales at Abercrombie & Fitch Co. and others. Weak customer traffic at malls has also concerned analysts, though Urban Outfitters continues to post increasing sales.

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Obama shops at Gap store, gives thanks to pay raise

Windsor Genova – Fourth Estate Cooperative Contributor

New York, NY, United States (4E) – President Barack Obama on Tuesday shopped for clothes at a Gap store in Manhattan in a gesture of thanks to the fashion retailer’s decision to raise the minimum wage of its workers.

Obama bought a gray and white striped sweater and a bright coral sweater for her daughters, Sasha and Malia, plus a blue workout jacket for wife and First Lady Michelle Obama at the Gap outlet on 42nd Street. A store clerk offered Obama to sign up for a Gap card to get a discount, but he declined.

After shopping, Obama congratulated Gap “for doing the right thing” in raising the minimum hourly pay of its workers this year to $9 and to $10 next year.

“It’s not only good for them and their families, it’s also good for the entire economy,” the President said, referring to Gap employees.

The Obama and fellow Democrats had called for businesses to raise the country’s minimum wage to $10.10 as Republicans and business and labor groups opposed a legislated wage increase.

The shopping trip in Manhattan came before Obama was to attend two Democratic party fundraisers in New York City. A Democratic National Committee fundraiser will be held at the private home of Alan Patricof, the founder of a successful New York venture capital fund. Patricof also raised money for Hillary Rodham Clinton’s Senate and presidential campaigns.

Supporters attending the fundraiser will pay $32,500 each, according to Washington Times.

The Democratic Senatorial Campaign Committee will also have its own fundraiser at another private home.

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Changes To Health Law Rules Include Extra Month To Enroll In 2015

United States (KaiserHealth) – The Obama administration on Wednesday released a broad set of regulatory changes to the health law that would give some consumers additional time to stay in plans that do not comply with all its coverage requirements and all consumers more time to enroll in coverage come 2015.

In response to reporters’ questions, an administration official said repeatedly that March 31 remains the enrollment deadline for consumers who want to get coverage on the health insurance exchanges this year. After problems with the rollout of the health law’s web site and lower-than-expected enrollment, there had been speculation that the deadline would be extended.

The rules changes, released jointly by the Department of Health and Human Services and the Treasury Department, were published now to provide certainty and clarity for consumers, employers and insurers, officials said. “Unlike last year, we’re putting out the policies early, they’re clear, people can rely on them,” an administration official said.

Administration documents also said the provisions were developed “in close consultation” with several members of Congress, including Senate Democrats Mary Landrieu of Louisiana and Jeanne Shaheen of New Hampshire. Both lawmakers are facing tough re-election campaigns this fall.

The changes include:

Allowing consumers who hold individual policies purchased before the health law went into effect and that do not meet the law requirements to stay in those plans for another two years if their state allows it and the insurer continues the plan. In November, President Obama had given individuals a one-year extension.

Extending the enrollment period for 2015 coverage from Nov. 15, 2014 until Feb. 15, 2015, one month longer than previously scheduled.

Changing the law’s reinsurance and risk corridor provisions, which are designed to help insurers manage the financial risk of taking all comers while keeping premiums affordable. The cap at which “reinsurance” kicks in would be lowered for 2014 from $60,000 to $45,000 in claims per person, then rise to $70,000 next year, with a reinsurance cap of $250,000 per person. Administration officials also said they would implement the risk corridors provision, which has been criticized by Republicans as a “bailout” for insurers, in a budget neutral fashion, with payments in equaling payments out.

Giving states until June 15 to determine if they want to operate their own health exchanges in 2015. Fourteen states and the District of Columbia currently operate their own exchanges, with the federal government operating them everywhere else.

Increasing annual limits for cost-sharing – deductibles, copays and coinsurance — limits for exchange policies in 2015. For individuals, those limits would rise to $6,600 from the current $6,400 and for families to $13,200 from the current $12,700.

In a statement, America’s Health Insurance Plans president and chief executive officer Karen Ignagni said her group was still reviewing the series of changes.

“There is broad agreement that if more young and healthy individuals choose not to participate in the new marketplaces, it could lead to higher premiums for those consumers that remain in the exchanges,” she said “That is why it is crucial that sufficient steps be taken to stabilize the market…”

Republicans criticized the decision to allow people to remain longer in plans that do not comply with the health law.

“Once again, the Obama administration has shown it will do whatever it takes to hide the true impact of ObamaCare from the American people – at least until after the next election,” said Sen. Orrin Hatch, R-Utah, ranking member of the Senate Finance Committee. “The fact is Americans should be able to keep the insurance – and the doctors and hospitals – of their choosing, as the president promised. Pushing this off for two more years isn’t a solution at all.”

Robert Laszewski, a consultant and former insurance industry executive, said in a note to his clients that allowing people to keep policies that don’t meet the law’s standards doesn’t bode well for insurers. Those policyholders need to sign up for new coverage – often at higher rates – to offset the costs of enrollees who are older or sicker, he said.

Brian Haile, senior vice president for health policy at tax service Jackson Hewitt, said adding a month to what was previously planned for the open enrollment period next year is a good idea. “Given that so many Americans are cash-strapped during Christmas,” he said, “the extension … to Feb. 15, 2015 is hugely beneficial to them – and the overall enrollment effort.”

Julie Appleby contributed to this article.

– Provided by Kaiser Health News.

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Bill Gates, at $76B, regains title as world’s richest person

Windsor Genova – Fourth Estate Cooperative Contributor

New York, NY, United States (4E) – Microsoft founder Bill Gates regained his title as the world’s richest person when the Forbes magazine’s billionaires list released on Monday estimated his current fortune at P76 billion.

Gates earned $9 billion from Microsoft shares last year, according to the U.S. business magazine, to top the list and end Mexican media mogul Carlos Slim Helu’s four-year reign as the world’s richest person. Slim dropped to second place with a net worth of P72 billion.

Still at third spot is Spain’s retailing mogul and Zara fashion chain owner Amancio Ortega with a $64 billion wealth followed by Warren Buffett, CEO and chairman of U.S. conglomerate Berkshire Hathaway, with $58.2 billion.

Americans led the Forbes list of 1,645 billionaires holding $6.4 trillion with 492, way more than China’s 152 and Russia’s 111. The Americans include gambling tycoon Sheldon Adelson, Facebook co-founder Mark Zuckerberg and fashion designer Michael Kors.

The list has 268 new billionaires, including Facebook Chief Operating Officer Sheryl Sandberg, Facebook vice president Jeff Rothschild, WhatsApp founders Jan Koum and Brian Acton, Dropbox CEO Drew Houston, Workday co-founder Aneel Bhusri, and World Wrestling Entertainment CEO Vince McMahon.

A total 172 in the list are women, 42 of whom are new billionaires. They include Oprah Winfrey, Spanx’s Sara Blakely and fashion designer Tory Burch.

Forbes calculated the worth of each billionaire in the list based on their assets, including stakes in public and private companies, real estate, yachts, art and cash.

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Alibaba Group Holding Ltd. to launch U.S. e-commerce website

Nathan Andrada – Fourth Estate Cooperative Contributor

Hangzhou, China (4E) – Alibaba Group Holding Ltd. announced that its two wholly owned subsidiaries in the U.S. are looking into launching a new e-commerce site in the country as part of its recent steps to expand into the world’s second biggest economy.

The company, which is set for an initial public offering that made analysts value it at over $100bn, said on Tuesday that it will kick off its initial majority-owned American e-commerce operations.

Two subsidiaries of the company’s business — Vendio and Auctiva — would soon launch the new site “11 Main” that offers products from select merchants in industries such as fashion and jewelry, according to an Alibaba spokeswoman on Tuesday.

In 2010, Alibaba acquired Vendio and Auctiva.

The latest move by Alibaba signals that the company is seeking other sources of growth. Alibaba’s websites account for 80 percent of China’s e-commerce market, and those sites saw their revenue rise by more than half to $1.78bn in the last quarter, but the pace of growth has slowed since 2013.

The decision by Alibaba is line with its longer-term goal of expanding into the U.S. The company now markets in the country through Aliexpress, an English language site that connects American businesses with Chinese wholesalers.

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Winter has left New York retailers in cold; apparel sales dip

NY, NY, United States (NewsBahn) – Blustery winter weather has left more people indoors and retailers feeling that they have been left out in the cold.

Overall retail sales were down the last three months, while apparel sales fell nearly a percentage point according to a report.

“This is definitely hurting us,” Lexy Funk, CEO of hipster fashion chain Brooklyn Industries, told the NY Post. “Winters are normally tough, but this is worse, with more snow days and much colder weather.”

As the weather improves in March and beyond, some analysts say retail sales could see a boost again.

“[More snow] is not going to help retailers, but it’s not like they can’t recover at some point during the year,” said Jim Rice, senior analyst at retail consultant Creditntell.

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Gap Inc. profit in Q3 tops analysts’ estimates

Nathan Andrada – Fourth Estate Cooperative Contributor

San Francisco, CA, United States (4E) – Gap Inc. reported a higher-than-forecast profit in the third quarter as mall retailers increased discounts to attract consumers before the holiday shopping season.

The largest U.S. specialty-apparel retailer said profit was $337mn, or 72 cents per share, for the three months ended Nov. 2, higher than $308mn, or 63 cents per share, a year ago. This month, Gap forecast per-share earnings of between 70 cents and 71 cents for the latest period.

Gap CEO Glenn Murphy has sought to draw customers to the Gap by launching new denim and fitness apparel while the Old Navy brand is becoming increasingly popular among shoppers looking for deals. For the quarter, net sales jumped 2.9 percent to $3.98bn, matching analysts’ average estimate.

Sales at stores open at least a year, also known as same-store sales, increased 1 percent. Gap’s namesake shops saw same-store sales rise 1 percent but those of Banana Republic fell 1 percent and were flat at Old Navy shops. Online sales surged 20 percent.

The company also approved a new $1bn share buyback program, with its existing plan has just $100mn in remaining authorization.

The San Francisco-based apparel retailer has posted higher same-store sales for seven straight quarters by introducing hot fashion trends, like its line of colored jeans in 2012.

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Bankruptcy judge approves Detroit debt restructuring, AFSCME appeals

Windsor Genova – Fourth Estate Cooperative Contributor

Detroit, MI, United States (4E) – Federal bankruptcy Judge Steven Rhodes said Tuesday Detroit is broke and is eligible for Chapter 9 protection setting the stage for the restructuring of the city’s more than $18 billion debt and other obligations.

The city’s labor union immediately appealed the ruling to the Sixth Circuit Court of Appeals, announced Lee Saunders, president of the American Federation of State, County and Municipal Employees (AFSCME), which represents thousands of retired Detroit employees.

Saunders said the bankruptcy decision was inhumane as it will allow the city to reduce pensions for retired city workers in spite of protections in the state constitution. About $3.5 billion out of Detroit’s $18 billion debt are pension obligations.

Saunders also b lasted Republican Gov. Rick Snyder for not excluding pension cuts from the bankruptcy plan. Snyder’s state-appointed emergency manager for Detroit, Kevyn Orr, has convinced Rhodes that the U.S. bankruptcy law supercedes pension protections under Michigan’s constitution.

Orr, in a press conference Tuesday, called for the city’s labor unions to negotiate reforms before he files a plan of adjustment for reducing the city debt by the first week of January.

Orr said unions should try to reach agreements with the city before debt-cutting solutions are imposed on them in bankruptcy court, according to

“We remain concerned about the need to adjust the city debt, to improve the level of services for citizens and to prepare for the city to exit this receivership in a fashion that restores democracy to the city,” Orr added.

Mayor Dave Bing urged parties to work together instead of fighting each other. Bing looked at the situation positively saying the restructuring is a chance for the city to move forward with a balance sheet free from debt and liabilities.

Detroit filed for Chapter 9 Bankruptcy protection on July 18, 2013 tobecome the largest city in the history of the United States to do so.

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