Ambulance services, cancer doctors top Medicare payment list

04/10/2014 3:00 PM

04/10/2014 3:01 PM

Eight of Medicaid’s 10 highest payments to health care entities in South Carolina for services in 2012 were in one specialty — ambulance service.

And the top five S.C. physicians on the Medicaid payment list were all in Myrtle Beach, four at the same practice.

The Centers for Medicare and Medicaid Services released national payment information for the first time Wednesday. The information has little value when it comes to consumer health care decisions. Instead, the federal agency said it hopes the media and the general public will use the information to help root out waste and fraud.

But the first thing most people ask is: Who got paid the most? The answer is ambulance services and cancer doctors. Sick elderly people need transportation, from home to hospitals, and elderly people often need the expensive drugs used to fight cancer.

“This data shows where we are spending the most money,” said Tony Keck, director of the S.C. Department of Health and Human Services. “It doesn’t necessarily mean it’s a problem” that a big chunk of the money is being paid to any one company or one physician.

The key, Keck said, is comparing costs per patient interaction. With additional crunching of numbers, the data should allow health experts to compare costs between individual practices, between regions or between states.

It shouldn’t be a surprise that the top of the South Carolina list is dominated by ambulance services. “A lot of our business is dialysis transpiration,” said Randy Guyton, owner of Gaffney-based AmbuStar, which received $2.81 million in Medicaid payments in 2012. “We take them in stretchers or in wheelchairs to get treatment.”

In a state with some of the highest rates of diabetes, which often leads to kidney failure, dialysis treatment is big business. AmbuStar also takes many elderly patients from their homes to hospitals or from nursing home to doctor visits.

“We do everything that EMS doesn’t do,” Guyton said.

And most of his business involves handling either the elderly covered by Medicare or the poor covered by Medicaid. That’s common in South Carolina.

Seventeen of the top 30 Medicaid payments in the state in 2012 went to ambulance companies. The top five were Personal Care in Charleston ($5.42 million in payments), Qzo Inc. in Aiken ($5.36 million), Carolina Medicare in Florence ($4.93 million), Medshore Ambulance Service in Anderson ($4.79 million) and Regional Ambulance Service based in the Aiken County town of Warrenville ($4.65 million).

Among the top 15 doctors in Medicare payment list in South Carolina are five from Coastal Cancer Center in Myrtle Beach — Dr. Renwick Goldberg ($3.23 million), Dr. Vijay Paudel ($2.93 million), Dr. Matthew Karpenko ($2.9 million), Dr. Lawrence Holt ($2.8 million) and Dr. Rebecca Cody ($2.33 million). Those figures represent payment for treatments, including chemotherapy sessions.

“The simple explanation is chemo drugs are very expensive,” said Deanna Cochran, chief financial officer at Coastal Cancer Center. “Family practice physicians don’t do chemo.”

Federal and state Medicare officials also noted that many of the top payments went to oncologists.

“Cancer doctors are going to have high bills,” Keck said. “But you need to try to understand what the practice patterns are.”

If one oncologist averages $5,000 in bills per patient and another averages $40,000 per patient, “then you start asking questions,” Keck said. “Are they treating different types of patients? Or are they just ordering lots of tests or lots of drugs?”

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