February 11, 2010

Texas, Pelosi and the doctor bills

Posted: 12:47 PM ET

A picture tells a thousand words: Taken in 2007, House Speaker Nancy Pelosi is cutting the ribbon at the brand new Women's Hospital at Renaissance outside McAllen, Texas.

Everyone is smiling, and with good reason.

Once the ribbon-cutting ended, the schmoozing and fundraising began. The party moved to the home of the developer who built the hospital. The Texas Monthly reported the developer, and the doctors who also invested in his beautiful, sprawling, for-profit medical complex, handed over $800,000 in donations for Pelosi's Congressional Democrats.

One day, $800,000.

Why would a group of doctors and a big developer give so much money to Nancy Pelosi? There's a lot at stake here.

Two national studies about Medicare costs show why McAllen, Texas is a good example of why health care is costing all of us so much.

In McAllen, the medical bill for the average Medicare beneficiary is almost twice as much as the national average, and health care costs are growing faster here than almost everywhere else in the country.

Just walk down any street and you can see why. On almost every corner, in almost every strip mall, every office building, there are doctor's offices, MRI screening centers, medical testing facilities.

And believe me, they are all in use. In our report for Campbell Brown's show, we'll tell you about one patient with a swollen ankle who went through so many tests–including an ultrasound for the abdomen and one to determine testosterone levels–the Texas Medical Board finally said enough.

What a Dartmouth Atlas study found interesting is that all this healthcare being delivered in McAllen does not actually add up to better health.

Which brings me back to that picture and why doctors would invite Speaker Pelosi to dinner and raise money for her?

One doctor who was at this very fundraiser said, "Look at it this way," he told me. "If you are going to take my money way, I am going to bring you to my house, serve you a nice dinner, and do all I can to convince you not to do it.”

In 2009, the hospital's political action committee also donated to House and Senate candidates, including Republicans.

Now, I am in no way implying here that all the donations paid off... but when members of the House of Representatives voted 395 to 34 in December to approve a $636.3 billion defense appropriations bill, tucked inside was a provision that delayed a planned 21.2% cut in Medicare physician payments until Feb. 28, 2010.

And just this week, Democrats proposed the passage of a new jobs bill with yet another two month delay in those Medicare cuts.

Those doctors at the Doctors Hospital at Renaissance near McAllen, Texas, must be smiling again. 75% percent of their patients are on Medicare or Medicaid.

The speaker's office did get back to us and took offense to any suggestion political donations influenced any votes in Washington. "The House has on several occasions passed provisions strongly opposed by these doctors and any attempt to ignore this fact is nothing more than a cynical ploy to reach a conclusion that is simply false," Pelosi spokesman Nadeam Elshami said in a statement to CNN.

As for the payments to doctors treating Medicare patients, the rules apply to all doctors, the speaker's office told us, not just those she was pictured with in McAllen.

picture above: Courtesy

Filed under: Drew Griffin • Special Investigations Unit

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steve   February 11th, 2010 4:37 pm ET

BS reporting

Pelosi's Congressional Democrats?
Pelosi got $800K?

Abraham Cassis   February 11th, 2010 5:59 pm ET

Mr. Griffin,

Pelosi is only interested in making health care available to illegal immigrants and all the tourist that come over the border in McAllen.

There is one way to solve the health care problem. It is related to CEO pay. It involves the idea that people in the health care industry are in the profession to help other people. Doctors, Nurses and Administrators should be in this business for its intrisic value not the extrinsic nature of the occupation. The bottom line is health care workers are overpaid. Medicine needs to be socialize and salaries need to be lower. Doctors and Nurses make alot of money for what they do. They should be thankful that they had the opportunity to choose these careers and stop sticking it to the rest of us.

From a Florida teachers with credentials in math, chem and physics who cannot find a job.
Sincerely Yours,

RickfromDetroit   February 11th, 2010 6:08 pm ET

I am always hearing complaints about Government Health Care, but the complaints are always against private sector Doctors.

I think the problem with our health care system is the same problem we have with our banks. It is called GREED! Furthermore, the solution to politics and campaign contributions could be eliminated if our Elected Officials were held responsible for their legislative policy making.

The current "HAIL MARY" legislative system rewards our Elected Officials with a touch down if the correct receiver catches the ball.

texan-mexan   February 13th, 2010 1:18 am ET

Your report is incomplete, because it has left out a very important culprit. As greedy as these doctors are, there is an even bigger one. They are the Home Health Agencies here. Can you believe McAllen has more home health agencies than most states in this country! And what they are doing is outright fraud.
They are wining and dining and pimping these (of course not all) corrupt docs and laughing all the way to the bank. I am not sure what the dumb FBI is doing about these home health thugs.

Anna   February 16th, 2010 12:21 am ET

Little insight into this hospital. They must have some powerful people on the payroll because they have been reported to just about every government agency including the Office of Inspector General. They have been milking medicare/medicaid. Been totally out of compliance, you name it and they do it. Give some of the crappiest care. They are all about the glitz and glamour. There COO has a high school diploma and no other credentials. Most of the people running the administrative part aren't even qualified to be where they are. There is no credentialing of the staff. So how do they do it?

Steve Levine   February 16th, 2010 11:23 am ET

Boy, are you out of whack on two fronts:

First, the 21.2-percent Medicare cut would further damage the fragile health care infrastructure in places like McAllen, where so many poor people depend on Medicare and Medicaid for their medical care. No physicians are "smiling" about the current state of affairs - even the freeze at current Medicare payment levels is a cut as the cost of providing care goes up. Over the past decade, medical inflation and frozen Medicare payments have added up to about a 15-percent cut for physicians who treat the elderly and people with disabilities.

Secondly, the Dartmouth Atlas data that the New Yorker article used to slam health care in McAllen leaves out much of what drives the cost of care there.

Medicare spending is not a good proxy for total health care spending:
a. Recent research published by Health Affairs showed that regional variation in Medicare spending is not related to total health care spending.
b. Areas with more total health care spending have more affluent populations who are more likely to be insured and have better lifetime access to health care.
c. Areas with high Medicare spending appear to have poor lifetime access to health care.

McAllen poses unique socioeconomic challenges for health care
a. The McAllen MSA is the poorest in the nation. Per-capita income in the McAllen MSA is $18,316, less than half the national average.
b. The poverty rate in McAllen is 34 percent, nearly triple the national average of 13 percent
c. More than 30 percent of McAllen residents are uninsured, compared to the national average of 17 percent.
d. About 13 percent of McAllen residents have diabetes, compared to the national average of 8 percent.

McAllen has the fewest physicians per capita of any place in the country
a. At 116 physicians per 100,000 population, the McAllen area has the lowest rate in the entire country and 43 percent fewer physicians than the U.S. average.
b. With just 45 primary care physicians per 100,000 population, the McAllen area is 37 percent below the U.S. average.
c. The addition of more than 60,000 households of “snowbirds,” mostly elderly visitors from northern climates who spend an average of 4 months each year in the Rio Grande Valley, adds to the pressure on an already overworked physician labor force.
d. The Health Affairs research shows that having more physicians is associated with better quality.
e. McAllen has a long recent history of serious problems with medical liability. Despite Texas’ highly effective 2003 health care liability reforms, McAllen’s history of a troubled liability climate has had a substantial effect on medical practice (defensive medicine) in the area, and undoubtedly has a role in the physician supply problems.
f. When there is poor availability of routine ambulatory care, patients are far more likely to get their outpatient care in hospital emergency rooms, where costs are high and diagnostic testing is more frequent, and they are far more likely to have costly hospital admissions. The Dartmouth Atlas data used in The New Yorker article confirms this, showing a pattern of unusually high inpatient cost in McAllen, while outpatient costs are close to the national average.

El Paso is not an appropriate comparison to McAllen
a. The New Yorker article compared the Dartmouth Atlas Medicare costs in El Paso, Texas, another poor city on the Texas-Mexico border, to those in McAllen. El Paso’s Medicare costs are close to the U.S. average.
b. While El Paso does indeed share many of socioeconomic characteristics with McAllen, it is in many ways far better off.
c. The number of physicians per 100,000 residents in El Paso is well below the national average but still 24 percent higher than in McAllen.
d. Per-capita income in El Paso is well below the national average but still 45 percent greater than in McAllen.
e. The poverty rate in El Paso is well above the national average but still 18 percent lower than in McAllen.
f. The prevalence of diabetes in El Paso is greater than the national average but still 27 percent lower than in McAllen.

Grand Junction, Colorado, and the Mayo Clinic service area are stark contrasts with McAllen
a. The New Yorker article used the lower Dartmouth Atlas Medicare costs associated with the integrated health care system in Grand Junction, Colorado, and the area surrounding the Mayo Clinic in Rochester, Minnesota, as examples of better controlled health care spending.
b. The socioeconomic characteristics in Grand Junction and Rochester are starkly different from those in McAllen.
c. Both Grand Junction and Rochester have twice as many physicians per 100,000 population as McAllen and both are above the national average (see chart).
d. Per-capita income in McAllen is 44 percent less than in Grand Junction and 55 percent less than in Rochester.
e. The poverty rate in McAllen is nearly three times what it is in Grand Junction and more than four times greater than in Rochester.
f. The uninsured rate in McAllen is nearly double what it is in Grand Junction and almost four times greater than in Rochester.

Home health care services in McAllen are tremendously out of line with the rest of the country
a. At $986 per enrollee in 2006, outpatient Medicare payments in McAllen were roughly in line with Grand Junction and the national average and actually 24 percent lower than in Rochester.
b. At $3,533 per enrollee, Medicare payments for home health services in McAllen were seven times the national average and three-and-one-half times the average for the state of Texas.
c. Medicare home health care payments in Rochester were one-seventh the national average; and in Grand Junction, they were 40 percent less than the national average.

Vicente Honrubia   February 16th, 2010 12:52 pm ET

It took 200 years for a population of underfed, illiterate, poorest citizens to have a decent State of the Art Hospital. What is wrong with this ?. As you rigthly report most of the patient are in medical. Why? Arent they deservers or humane care or should we euthanize them ?

You miss the point, reform the system that creares such disparated situation. And be thaunkfull that they are doctors that took upon themselves the responsability of the goberment

adetunji ojo   February 16th, 2010 1:57 pm ET

thanks mr griffin, i am a nurse with background in mechanical engineering, when manufacturing jobs tanked, i went back to nursing school and doing better than before. it is called changing with changing times, be flexible, use your background in maths, physics and chemistry for nursing degree if you think they make too much and you can't find a teaching job. it is called adaptation even animals do.

tj michigan

texan-mexan   February 18th, 2010 11:36 pm ET

Steve levine,
You are reeling off reems of data, but have you ever thought if they are true? You know, there are lies, damn lies and then Statistics!
As someone who lives in McAllen, I can vouch that the income data is pure bullshit. Most of the transactions are done in cash and never reported.Most people in this town are on Medicaid not because they are poor, but because they can! They drive Escalades, flaunt Coach bags, but also swipe their Lone star card(for food stamps), go to their clinics and get paid for the transportation by Medicaid!
Now, it is in human nature to be dishonest to some extent. Everyone lies in their tax return a bit, but what is going on in this town is in a different logarithmic scale, almost surreal. There is a well knit mafia of Hospitals-Home Health agencies-Ambulance companies-DME companies and Physicians and Physician Assistant/Nurse practitioners.
And for the record, Dr. Vicente Honrubia is one of the biggest investors in this "state-of-the art" hospital. He should have disclosed it himself, but, hey, you are talking about McAllen!

geoc   February 23rd, 2010 6:22 pm ET

Most doctors in McAllen Texas are not real doctors.
To see a real doctor you have drive to San Antonio, Austin, ect.
They are all money hungry. Mafia
I wish that somebody would check there license. They do not care for your health it is the $$$$$$$$$. Give me more $$$$$$$$$$$$.
Doctors Hospital same way.

Jack Kay   February 24th, 2010 10:59 am ET

Yet you can't get in to actually see a Doctor in McAllen,TX

Cory   February 27th, 2010 12:27 am ET

How funny that someone complains about how much a nurse makes, no matter where we work the money we make is nothing compared to the work we do. As a nurse I work anywhere between 8 to 12 hours a day. We don't get to leave at 3pm. As for working as a nurse I'm the rio grande valley and particularily in the McAllen area what mr. Levine is stating sounds true. Have any one of you whom complain about misuse ever walked into one of these patients homes? Have you ever seen to their welfare? Have any one of you ever tried to help buy their meds? Probably not...... Yes there is rampant misuse of Medicaid, I've seen it myself and being someone who put herself through school to get where I'm at, it angers me. But you people need to leave us alone, stop the verbal abuse and help the people of south Texas, not hurt us.

Pablo Carrerras   March 4th, 2010 1:15 am ET

Mr. Griffin I congratulate you for your special investigation unit on McAllen Texas. Please come down and interview physicians in the trenches and see how medicine is realy practiced in McAllen.

You have touched the tip of the iceburg. Please contact me soon. Abuse includes medicaid fraud, wrongful diagnosis, extended stays in hospitals, hospitals practicing deceptive business practices with doctors who refer to them. It's really disgusting. I would love to meet with you for a follow up story....

Smith in Oregon   May 9th, 2010 6:51 pm ET

It is entirely refreshing given the horrific heavy crude Oil spill gushing in the once pristine Gulf of Mexico that Media and Public discussion has turned to the huge ongoing grievous harm that Petrol-Chemicals have done to ALL Americans and ALL humans living and breathing on earth.

For many years I have complained sometimes loudly that 'we' are being bathed in carcinogenic chemicals in the air and in our food as a result of Big Oil, Big Coal and Big on burning fossil fuels.

These carcinogenic chemicals cause a wide range of diseases which impact all humanity on earth and cost Americans an enormous amount on resulting Health Care just dealing with those suffering directly and indirectly from chronic exposure to Petro-Chemicals.

How many millions were chronically exposed and poisoned by LEAD when Big Oil placed Lead in Gasoline for decades? Everyone knew blackberry's and fruit that grew along the roads in America were heavily contaminated with LEAD.

Was Big Oil sued and forced to pay for millions of infants and adults suffering from chronic LEAD poisoning? Of course not, they owned the courts and most of the Republican lawmakers.

How many millions were chronically exposed and poisoned by Wood Alcohol which former President Big Oil Bush sr. ordered to add to Gasoline? Wood Alcohol is a known carcinogen and a strong poison in aquifers and ground water across America became contaminated with Wood Alcohol as a result.

Was Big Oil sued and forced to pay for millions of infants and adults suffering from Wood Alcohol poisoning? Of course not, they owned the courts and most of the Republican lawmakers.

Imagine the same Republican lawmakers entirely outlawing and banning many recreational drugs whose LD50 toxicity is so large it is practically impossible to ingest a life threatening amount, AND yet those same corrupt lawmakers and jurists declare it is fine for their Big Oil and Big Coal primary donors to pour, spew and produce enormous amounts of extremely toxic chemicals which end up in your food, in the air you breath and in the water YOU drink!

The current system of vastly corrupt laws and regulations places the burden on the government to prove that a chemical is unsafe before it can removed from the market. The standards are so high, the government has been unable to ban chemicals such as asbestos, a widely recognized carcinogen that is prohibited in many other countries.

About 80,000 chemicals are in commercial use in the United States, but federal regulators have assessed only about 200 for safety.

Big Pharma's products that are being flushed down the toilets across America and around the world are poisoning everyone downstream whose local and city water supply's depend on that fresh water.

Mother's milk is increasingly being ever more contaminated with dangerous Petro-Chemical's. For decades Big Oil and Big Coal have been protected from laws and regulations which would force them to deal with the results of their products. Force them to pay for the damage they cause and the diseases that result.

Mothers across America and around the world should stand up against Big Oil and Big Coal and demand they and their toxic chemicals be held entirely accountable for any and all ill effects they produce and contribute to the infant and human condition.

Ted   July 6th, 2010 10:28 pm ET

As you can see CNN is hiding this story as much as possible. Pelosi must have paid them off too. Obama has Ted Turner in his pocket. You will never hear about the Black Panthers story in Philadelphia.during the election on CNN eather.

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