From Business Week:
"A key U.S. Senator is asking federal officials to investigate after reviewing data that shows doctors across the country prescribing alarmingly high numbers of powerful mental health drugs paid for by Medicare and Medicaid..
Grassley did not name the doctor, but state records obtained by The AP show Dr. Fernando Mendez-Villamil wrote an average of 153 prescriptions a day for 18 months ending in March 2009. That's nearly twice the number of the second highest prescriber in Florida, who wrote a little more than 53,000 prescriptions, according to a list compiled by state officials.
The doctor's attorney, Robert Pelier, said his client tried to contact Grassley to explain the data but got no response.
"Dr. Mendez-Villamil is a specialist that has treated the most afflicted and poor in the area" and has never acted improperly, Pelier said. He filed a lawsuit against the state alleging authorities tried to terminate him from being a Medicaid provider "without cause."
Federal officials said they stopped reimbursing Villamil after Grassley inquired about the doctor to HHS in December."
Nice work. And welcome to another aspect of Obamacare: Targeting and terminating payment of doctors who are fingered by the feds for providing "too much" treatment.. Having Grassley serve as a bounty hunter is optional.
I thought it would be nice to hear Dr. Mendez-Villami's side of the story since most media accounts gloss over it. I found this letter he wrote to HHS. You tell me if this sounds like a crook or just one more honest and hardworking doctor who will ultimately bag Medicaid because of the reimbursement cuts and threat of retaliation.
PS.. Here's something CMS and Grassley overlooked: No one gets rich writing prescriptions.. Where is the fraud. Is it a criminal activity to prescribe more than what a Senator regards as "normal?"
Why isn't anyone raising hell about this abuse of power?
Dear Senator Grassley,
I am writing to add a human face -- along with some background information and context -- to whatever image you may have of the doctor in Miami who wrote all those prescriptions for mental health drugs.
I am that doctor. My name is Fernando Mendez-Villamil and I have practiced psychiatry in South Florida since 1998. I received my medical degree from the Universidad Central del Caribe in Puerto Rico and performed my residency in psychiatry in Jackson Memorial Hospital, the public medical center serving metropolitan Miami.
I can only imagine what you thought when you were given information by the Florida Agency for Health Care Administration showing that one doctor wrote close to 97,000 prescriptions for mental health drugs over 21 months. This came to 153 prescriptions a day, 7 days a week for that entire period; twice as many prescriptions in that period as the number 2 Medicaid prescriber in the state.
These numbers may have struck you as an indication something was wrong. Frankly, since I have never stopped to do such a calculation, it seemed a little peculiar to me too. I never felt I was treating an extraordinary number of people or writing an exceptional number of prescriptions.
At the same time, I never thought I would be faulted for working hard or for being very organized and efficient. But now - with this publicity and the questions it has engendered - I have looked at the matter carefully and would like to provide you and the public with some context within which to consider these facts.
First, I want you to know that I take very good care of my patients. My top priority is to improve their conditions. In more then ten years of practice I have worked with thousands of afflicted individuals. Their conditions have ranged between mild emotional upset to extreme debilitating psychosis.
By every indication, my patients and their families are pleased with my care.
I may be an oddity as a physician because I do not play golf, I do not have a boat and I seldom leave my practice for extended vacations and am involved in my practice on a daily basis. That is not to solicit sympathy or to appear “noble.” I am simply committed to my patients, profession and enjoy what I do and do not seek distractions.
As to my patients, they share some characteristics.
* Many receive a combination of medications with each drug addressing specific aspects of their condition identified by the use of objective clinical findings along with subjective complaints. Therefore, when I see such patients I must write or renew an average of three or four prescriptions.
* Some patients come to me after having been under the care of other medical providers who prescribed some of these medications. I must evaluate whether those drugs are effective in achieving their treatment objectives, whether some medications should be discontinued and whether additional medications are required. This can be a very difficult process when I am dealing with a mentally ill patient who may not be able to assist fully in the examination process. I would like you to know that these efforts are in combination with initial and ongoing psychiatric assessments of my patients.
* Ongoing treatment plans with the use of atypical antipsychotic medication is necessary in order to maintain patients stable and effectively responsive to their mental health needs. I firmly believe that a person’s health should not be placed in danger by erratic or ineffective treatment.
* As a result of my assessments and treatment plans I have initiated; most of my patients are very stable and experience very few changes in behavior or in their medical condition over time. Of great importance is the fact that hospitalization rates of my patient population are less than 1%. Hospitalization can be costly and otherwise interrupt the mental health and wellbeing of the patients. While I seek to be alert of subtle variations in my patient’s responsiveness to the treatment or behavior that might indicate a need to alter their regimen, you may appreciate that my patients are not always able to reliably explain how a drug is affecting them. Chronic mental health patients require complex combinations of medications based on their past treatment, physiological and psychological needs.
As to the specific prescriptions I have written, I have asked the Florida Agency for Healthcare Administration to provide me the information that was presumably provided to you and consequently to media outlets. The department has responded to my request by saying they have not received any recent requests for information about me or my practice and could therefore not furnish me with such information.
The information received from this agency advised that I am not under any sort of investigation. It also appears that the circumstances surrounding the release of the information to you supports this also. This was good to hear because I would hate to think that the government would discourage hard work and efficiency in the delivery of medical care.
In a similar vein, I was very surprised to read in the Miami Herald that Medicare had supposedly stopped payment for my services; and I am very pleased to confirm with Medicare officials that this was NOT true.
As to the numbers of prescriptions that have been cited, let us look at them on a hypothetical basis and see what they show.
Assuming the numbers are correct, I wrote 97,000 prescriptions in 21 months.
AHCA does not indicate how many patients were involved. However, again assuming those numbers are correct I believe the following would outline the pertinent facts in this matter.
Spread over 21 months, on an average six day, sixty to sixty-three hour work week that comes to approximately 4619 prescriptions per month. It is also not uncommon for me to actually work beyond these hours if there patients that need to be seen; as my practice is mainly a walk in, first come first served office.
At my average work schedule of 22-24 days per month, that means I saw between 47-55 patients a day and wrote an average of 210 prescriptions. That averages to 2-3 prescriptions per patient per appointment. Please remember that most of my patients are seen every other month; are given refills and my services are focused on the ongoing administration, effectiveness and responsiveness of the medication treatment plan I have prescribed for these patients. Time wise, I average 10-15 minutes per patient.
Generally, I work an average workday of 11-12 hours. Not counting one hour in the aggregate for lunch and other non patient related activities, I see roughly four patients per hour.
Given the stable nature of my patients –these efforts are reasonable and well within the norms of modern psychiatric practice and in treating my patient population. This is especially true given that mine is a psychiatric practice that rarely involves time-consuming psychotherapy, physical contact or examination of the full range of vital signs. Please keep in mind that the interaction I have with my patients is a combination of patient assessment, monitoring and evaluation of a continuing course of treatment as to the effectiveness of the patient’s medication regimen and/or treatment.
Senator, I certainly appreciate your efforts to monitor matters such as this. Our country’s health care system is vast and complicated and seemingly includes much inefficiency. I hope you continue your good work with vigilance and determination.
However, in my case I assure you there is absolutely no cause for concern or alarm.
And I probably COULD use a nice vacation.
Respectfully,
Fernando Mendez-Villamil, M.D.
EMAIL: mendezvillamildr@gmail.com
cc: The Honorable Kathleen Sebelius
Secretary, U.S. Department of Health and Human Services
Charlene Frizzera
Acting Administrator, Centers for Medicare and Medicaid Services
U.S. Department of Health and Human Services
The Honorable Thomas W. Arnold
Secretary, Agency for Health Care Administration
State of Florida
