50 Doctors in RI with the Most Medicare Prescription Claims

Tuesday, June 16, 2015

GoLocalProv News Team and Kate Nagle

Over 35 million Americans were prescribed Medicare Part D drugs in 2013 by 1.3 million providers, for a total of 1.4 billion prescriptions -- costing over $103 billion.

In Rhode Island, the top five prescribing doctors had over 230,000 Medicare Part D claims filled during that time frame, for drugs having a total retail price tag of over $11 million, according to data compiled by ProPublica. 

"Yes, there is all of this information available online now, but what you don't see in these numbers is what kind of patients are being treated, and what is the severity of their ailments," said Steve DeToy, Director of Government and Public Affairs with the Rhode Island Medical Society.  "So while this data has to be reported - and released --  it needs be viewed in the appropriate context. You need to look closely at the doctors' patient mix."

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SLIDES: #50 to #1 - Doctors in RI With the Most Medicare Prescription Claims BELOW

GoLocalProv reviewed data collected by non-profit media watchdog ProPublica, who has been collecting and organizing federal data from new federal reporting requirements impacting the Centers for Medicaid and Medicare (CMS).  

"The number of prescriptions is just one of many data points that should be reviewed, again, in the appropriate context," said DeToy.  "We had a data dump a while back as to who billed Medicare.  As it turned out,  80% was a pass through of what [the doctors] had already spent.  So Oncology, for instance -- they put out a lot, and then get reimbursed.  It can look like these doctors are making millions, and they're not."

Top RI Prescribers -- and Drugs

Dr. Huo Huang, an internal medicine specialist in Cranston, had 83,917 Medicare Part D prescription claims filled for 1,568 patients receiving at least one drug in Part D in 2013, for a total retail price of just over $4 million.  

Huang averaged of 54 prescriptions (including refills) per patient, compared to the state average of 21 for internal medicine.

Dr. Michael Klufas, a geriatric medicine specialist in Cumberland, had 46,702 Medicare Part D prescription claims filled, including refills, for an average of 43 prescriptions per patient; Dr. Shahzad Khurshid, an internal medicine specialist in Cranston, was third highest statewide with 38,060 prescription claims. 

Statewide, the top drugs prescribed under Medicare Part D in 2013 were Lisinopril, which treats high blood pressure (211,554 claims); Omerprazole, which treats heartburn and stomach ulcers (190,686 claims); and Amlodipine Besylate, which treats high blood pressure and chest pain (181,903 claims).

The highest costing drugs prescribed? The well-advertised Advair, Spiriva, Abilify, Cymbalta, and Crestor were the top five, with just under 150,000 claims costing $46,261,480.

ProPublica Prescription Concerns

In his report, "One Nation, Under Sedation: Medicare Paid for Nearly 40 Million Tranquilizer Prescriptions in 2013", ProPublica's Charles Ornstein wrote,  "A worrisome aspect of the newly released data is that some doctors appear to be prescribing benzodiazepines and narcotic painkillers to the same patients, increasing the risk of misuse and overdose. The drugs, paired together, can depress breathing."

"Congress wouldn’t allow Medicare to pay for benzodiazepines such as Xanax and Ativan until 2013," wrote Ornstein. "Now, the medications are among the most prescribed in its drug program."

ProPublica lists Alprazolam (Xanax), Lorazepam (Ativan), Clonazepam (Klonopin), Diazepam (Valium), and Temazepam (Restoril) as the the most-prescribed benzodiazepines in 2013 across the U.S.

In Rhode Island, these benzodiazepines prescriptions ranked this way:

Clonazepam (Klonopin) - 56,601 claims (Total cost of $418,358)
Alprazolam (Xanax) - 47,306 claims filled ($319,799)
Lorazepam (Ativan) - 47,013 claims filled ($396,801)
Diazepam (Valium) - 18,938 claims filled ($153,712)
Temazepam (Restoril) - 8,297 claims filled ($130,574)

According to HealthGrove,  at $1.01 Billion, Rhode Island is ranked seventh in America for its total Medicare costs. This cost is distributed among 107,390 Medicare beneficiaries which amounts to $9,409 per person. Controlling for differences in payment rates for individual services across the country, standardized costs are $8,376 per person. Further adjusting for risk, Medicare in Rhode Island typically costs the government $8,662 per person, 8.0% lower than the national average.

Rhode Island - Featured Visualization | HealthGrove

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Related Slideshow: #50 to #1: Doctors in RI with the Most Medicare Prescription Claims

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