Susan Gallagher MD

Gender: F
Medical School: Ohio State University College Of Medicine
Graduation Year: 1981
Primary Specialty: Internal Medicine

2017 Medicare Provider Charge and Payment Data

Medicare Participation?Y
Number of unique HCPCS codes submitted23
Total Provider Services3544
Total Medicare beneficiaries receiving the provider services570
The total charges that the provider submitted for all services$425,990.00
The Medicare allowed amount for all provider services. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.$304,397.15
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item services.$216,659.68
Total Medicare Standardized Payment Amount$234,634.73
Total number of HCPCS codes for drug services, as defined from the Medicare Part B Drug ASP File1
Total drug services, as defined from the Medicare Part B Drug ASP File39
Total Medicare beneficiaries receiving drug services, as defined from the Medicare Part B Drug ASP File.39
The total charges that the provider submitted for drug services, as defined from the Medicare Part B Drug ASP File.$975.00
The Medicare allowed amount for drug services, as defined from the Medicare Part B Drug ASP File. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.$937.95
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item drug services, as defined from the Medicare Part B Drug ASP File.$919.23
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for the line item drug service , as defined from the Medicare Part B Drug ASP File and after standardization of the Medicare payment has been applied. Standardization removes geographic differences in payment rates for individual services, such as those that account for local wages or input prices and makes Medicare payments across geographic areas comparable, so that differences reflect variation in factors such as physicians’ practice patterns and beneficiaries’ ability and willingness to obtain care.$919.23
Total number of HCPCS codes associated with medical (non-ASP) services22
Total medical (non-ASP) services3505
Total Medicare beneficiaries receiving medical (non-ASP) services570
The total charges that the provider submitted for medical services (non-ASP)$425,015.00
The Medicare allowed amount for medical (non-ASP) services. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.$303,459.20
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item medical (non-ASP) services$215,740.45
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for the line item medical (non-ASP) service , as defined from the Medicare Part B Drug ASP File and after standardization of the Medicare payment has been applied. Standardization removes geographic differences in payment rates for individual services, such as those that account for local wages or input prices and makes Medicare payments across geographic areas comparable, so that differences reflect variation in factors such as physicians’ practice patterns and beneficiaries’ ability and willingness to obtain care$233,715.50
Average age of beneficiaries76
Number of beneficiaries under the age of 6554
Number of beneficiaries between the ages of 65 and 74198
Number of beneficiaries between the ages of 75 and 84176
Number of beneficiaries over the age of 84142
Number of Female beneficiaries401
Number of Male Beneficiaries169
Number of Non-Hispanic White Beneficiaries487
Number of Black or African American Beneficiaries65
Number of Medicare beneficiaries qualified to receive Medicare only benefits. Beneficiaries are classified as Medicare only entitlement if they received zero months of any Medicaid benefits (full or partial) in the given calendar year476
Number of Medicare beneficiaries qualified to receive Medicare and Medicaid benefits. Beneficiaries are classified as Medicare and Medicaid entitlement if in any month in the given calendar year they were receiving full or partial Medicaid benefits94
Percent of beneficiaries meeting the CCW chronic condition algorithm for atrial fibrillation16%
Percent of beneficiaries meeting the CCW chronic condition algorithm for Alzheimer’s, related disorders, or dementia18%
Percent of beneficiaries meeting the CCW chronic condition algorithm for Asthma5%
Percent of beneficiaries meeting the CCW chronic condition algorithms for cancer. Includes breast cancer, colorectal cancer, lung cancer and prostate cancer11%
Percent of beneficiaries meeting the CCW chronic condition algorithm for heart failure22%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney disease49%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic obstructive pulmonary disease22%
Percent of beneficiaries meeting the CCW chronic condition algorithm for depression24%
Percent of beneficiaries meeting the CCW chronic condition algorithm for diabetes43%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hyperlipidemia38%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hypertension73%
Percent of beneficiaries meeting the CCW chronic condition algorithm for ischemic heart disease38%
Percent of beneficiaries meeting the CCW chronic condition algorithm for osteoporosis7%
Percent of beneficiaries meeting the CCW chronic condition algorithm for rheumatoid arthritis/osteoarthritis56%
Percent of beneficiaries meeting the CCW chronic condition algorithm for schizophrenia and other psychotic disorders5%
Percent of beneficiaries meeting the CCW chronic condition algorithm for stroke7%
Average Hierarchical Condition Category (HCC) risk score of beneficiaries1.5433

Source: data.cms.gov

Susan Gallagher MD's 2017 Charges to Medicare:

Services Description Times Provided Beneficiaries Beneficiaries per day Medicare Avg. Amt. Average Charge Avg Medicare Payment Percentage of Average
Vaccine for influenza for administration into muscle, 0.5 ml dosage 39 39 39 $24.05 $25.0 $23.57 106%
Established patient office or other outpatient visit, typically 15 minutes 748 288 748 $69.51 $90.41 $45.29 200%
Established patient office or other outpatient, visit typically 25 minutes 1149 344 1149 $102.44 $127.43 $70.15 182%
Established patient office or other outpatient, visit typically 40 minutes 37 35 37 $138.24 $227.41 $100.72 226%
Hospital observation care typically 30 minutes 15 15 15 $97.01 $163.33 $74.54 219%
Hospital observation care typically 70 minutes per day 21 21 21 $180.46 $213.0 $138.65 154%
Initial hospital inpatient care, typically 50 minutes per day 102 86 102 $131.08 $185.12 $99.39 186%
Initial hospital inpatient care, typically 70 minutes per day 43 40 43 $196.96 $232.47 $151.33 154%
Subsequent hospital inpatient care, typically 25 minutes per day 724 168 724 $70.13 $117.36 $53.57 219%
Subsequent hospital inpatient care, typically 35 minutes per day 187 65 187 $101.41 $142.35 $77.92 183%
Hospital discharge day management, 30 minutes or less 120 101 120 $70.11 $163.0 $53.08 307%
Subsequent nursing facility visit, typically 15 minutes per day 209 43 209 $66.53 $102.0 $48.67 210%
Subsequent nursing facility visit, typically 25 minutes per day 25 20 25 $88.05 $132.0 $67.65 195%
Administration of influenza virus vaccine 39 39 39 $5.0 $5.0 $4.9 102%
Source: 2017 Provider CMS Charge Data