pricey procedures lead to outsized medicare...

6
The Associated Press TALLAHASSEE — Florida’s Republican-con- trolled Legislature is the middle of another contentious session where it’s deciding every- thing from the future of gambling in the state to whether or not grocery stores can sell liquor in their aisles. And the corporations, trade associations and law rms with a stake in the outcome of this year’s session have ooded the campaign accounts of the two major parties, as well as accounts connected to Senate President Andy Gardiner and Gov. Rick Scott. New campaign reports led late Friday show that more than $7 million was donated to the Republican Party of Florida and the account controlled by Gardiner. In January, Republican activists rejected Scott’s hand-picked party leader and instead elected state Rep. Blaise Ingoglia to lead the state GOP. The Senate went out on its own and set up a separate fundraising account after the change. Scott himself has also reinvigorated his own fundraising account called Let’s Get to Work, which has pulled in $1.1 million since Ingoglia took over. The Florida Democratic Party, which has been dealing with a string of setbacks in recent elections, received roughly $2.75 million in cash donations during the rst quarter of 2015. Most of that came from a Jacksonville political committee which itself has received money from key gures in that city including Jacksonville Jaguars owner Shad Khan. Current Democratic Mayor Alvin Brown is locked in a tight re-election battle against former Republican Party of Florida chairman Lenny Curry. SPIETH LEADS BY 4 STROKES AT MASTERS, 1C By Fred Hiers Staff writer N o cardiologist in the United States got more Medicare reim- bursement mon- ey during 2012 than Dr. Asad U. Qamar of Marion County. Only one other phy- sician of any kind got more from the program. The dis- tinctions were not achieved by chance. Qamar performed more than 1,300 of the most costly surgical proce- dures in his area of expertise on Medicare patients during 2012, which is the latest year for which full data are available. No other cardiologist in America came close to performing that number of procedures, according to an analysis of Medicare billing data. “That’s obscene. I’m having chest pains” just considering those procedure numbers, said Dr. Darren B. Schneider, chief of vascular and endovascular surgery at New York-Presbyterian Hospital/Weill Cornell Medical Center. Schneider is on a four-cardiologist team that performs peripheral revascularizations. He said his group performs revascularizations on patients with peripheral artery disease only when the patients have dis- abling leg pain or are at risk of amputation. That amounts to fewer than 10 percent of all the patients the group treats. 0 0 90994 24007 For Home delivery call: 867-7827 Toll Free: 1-800- 541-2171 © 2015 Ocala Star-Banner Ocala, Florida, Vol. 72, No. 199, eight sections TODAY: Showers. 60% chance of rain. TOMORROW: High: 83, Low: 67 65% chance of rain. 5-day forecast, 8B BOOKS 6F BUSINESS 20A CLASSIFIED 1E CROSSWORD 4F EDITORIAL 16A LOCAL 1B LOTTERY 2A OBITUARIES 6B PEOPLE 2A SPORTS 1C TELEVISION 4F TRAVEL 3F INDEX HIGH 84 LOW 67 Sunday, April 12, 2015 www.ocala.com $2.00 SUNDAY $300 UP TO INSIDE IN COUPON SAVINGS Cities oppose pension bill they believe favors unions BRUCE ACKERMAN/STAFF PHOTOGRAPHER The Institute of Cardiovascular Excellence is shown near the Market Street at Heath Brook shopping center on State Road 200 in Ocala on Thursday. Pricey procedures lead to outsized Medicare payout Area cardiologist frequently performs treatments others rarely do Fla. parties ush with money from interest groups With their gambling deal set to expire, the Seminole Tribe is among key donors this year. OBAMA, CASTRO VOW TO TURN THE PAGE, 3A HUNDREDS JOIN VIGIL FOR FALLEN OFFICER, 1B A comparison of the 10 cardiologists in the United States who received the most Medicare payments in 2012 to the number of patients for whom the provider charged the national program. Shown in the graphic below, Dr. Asad Qamar received the most Medicare payments of any cardiologist in the country while seeing a comparatively similar number of patients as the other doctors. ROB MACK/Staff graphic SOURCE: Centers for Medicare & Medicaid Services Top 10 cardiologist Medicare-payment recipients and number of patients $4.5 M 1,662 #2 Ashish Pal Davenport, Fla. $3.68 M 1,374 #3 Kusai Aziz Visalia, Calif. $3.52 M 3,102 #4 Shashi Sharma Visalia, Calif. $3.44 M 753 #5 Nagender Reddy Ocala $3.35 M 4,390 #6 Rajen Maniar Flushing, N.Y. $3.32 M 1,713 #7 Vinod Kumar Bakersfield, Calif. $2.73 M 2,250 #8 David Lew Leesburg $2.73 M 2,321 #9 Klaus Rentrop New York, N.Y. $2.63 M 2,321 #10 Parag Doshi Schaumburg, Ill. $18.2 M 1,798 #1 Asad Qamar Ocala Payments Medicare patients YOUTUBE.COM Dr. Asad Qamar of the Institute of Cardiovascular Excellence is shown in a still from a YouTube video he prepared in his defense. By Zac Anderson Halifax Media Services Many cities across Florida have serious pension problems, with roughly $10.5 billion in unfunded liabilities spread across 491 municipal plans. Some cities have been raising taxes in recent years to keep up with the costs. State lawmakers say they want to help, but in an unusual twist, city leaders are accusing the Republican-controlled Legislature of favoring unions over local taxpayers and supporting legislation that would actually make it more difcult for cities to reduce their pension liabili- ties and cut benets. The local pension bills are pitting cities against police and re unions, which historically have held signicant sway over Republican lawmak- ers. The unions are unhappy with how Gov. Rick Scott’s administration has interpreted state pension law. They are strongly supporting a bill that advanced in the House this week — and similar legislation moving quickly through the Senate — that provides new rules for dividing state funds allocated for police and re pensions. City ofcials say the legislation would limit their ability to drive hard bargains with unions. Know the symptoms of a heart attack and trust Ocala Health for your emergency needs. Ocala Regional Medical Center West Marion Community Hospital Text ER to 23000 for ER Wait Times Online at Ocala.com To see a database of Medicare payments for 2012, visit www.ocala.com/medicare INSIDE TODAY: SUMMER PLANNER A comprehensive parents’ guide to area summer camps and activities, summer-long entertainment and more. a.co om m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m R Coming Monday Patients express admiration for Dr. Qamar, but he also faces two whistle- blower lawsuits. QAMAR on Page 6A FUNDRAISING on Page 10A PENSIONS on Page 10A

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Page 1: Pricey procedures lead to outsized Medicare payoutcdn.gatehousemedia.com/custom-systems/ghns/files... · $3.44 M 753 #5 Nagender Reddy Ocala $3.35 M 4,390 #6 Rajen Maniar Flushing,

The Associated Press

TALLAHASSEE — Florida’s Republican-con-trolled Legislature is the middle of another contentious session where it’s deciding every-thing from the future of gambling in the state to whether or not grocery stores can sell liquor in their aisles.

And the corporations, trade associations and law fi rms with a stake in the outcome of this year’s session have fl ooded the campaign accounts of the two major parties, as well as accounts connected to Senate President Andy Gardiner and Gov. Rick Scott.

New campaign reports fi led late Friday show that more than $7 million was donated to the Republican Party of Florida and the account controlled by Gardiner.

In January, Republican activists rejected Scott’s hand-picked party leader and instead elected state Rep. Blaise Ingoglia to lead the state GOP. The Senate went out on its own and set up a separate fundraising account after the change.

Scott himself has also reinvigorated his own fundraising account called Let’s Get to Work, which has pulled in $1.1 million since Ingoglia took over.

The Florida Democratic Party, which has been dealing with a string of setbacks in recent elections, received roughly $2.75 million in cash donations during the fi rst quarter of 2015. Most of that came from a Jacksonville political committee which itself has received money from key fi gures in that city including Jacksonville Jaguars owner Shad Khan.

Current Democratic Mayor Alvin Brown is locked in a tight re-election battle against former Republican Party of Florida chairman Lenny Curry.

SPIETH LEADS BY 4 STROKES AT MASTERS, 1C

By Fred HiersStaff writer

No cardiologist in the United States got more Medicare reim-bursement mon-ey during 2012 than Dr. Asad U. Qamar of

Marion County. Only one other phy-sician of any kind got more from the program. The dis-tinctions were not achieved by chance.

Qamar performed more than 1,300 of the most costly surgical proce-dures in his area of expertise on Medicare

patients during 2012, which is the latest year for which full data are available.

No other cardiologist in America came close to performing that number

of procedures, according to an analysis of Medicare billing data.

“That’s obscene. I’m having chest pains” just considering those procedure numbers, said

Dr. Darren B. Schneider, chief of vascular and endovascular surgery at New York-Presbyterian Hospital/Weill Cornell Medical Center.

Schneider is on a four-cardiologist team that performs peripheral revascularizations. He said his group performs revascularizations on patients with peripheral artery disease only when the patients have dis-abling leg pain or are at risk of amputation. That amounts to fewer than 10 percent of all the patients the group treats.

0 090994 24007

For Home delivery call: 867-7827Toll Free: 1-800-541-2171

© 2015 Ocala Star-BannerOcala, Florida, Vol. 72, No. 199, eight sections

TODAY: Showers. 60% chance of rain.

TOMORROW: High: 83, Low: 6765% chance of rain. 5-day forecast, 8B

BOOKS 6FBUSINESS 20ACLASSIFIED 1E

CROSSWORD 4FEDITORIAL 16ALOCAL 1B

LOTTERY 2AOBITUARIES 6BPEOPLE 2A

SPORTS 1CTELEVISION 4FTRAVEL 3F

INDEXHIGH

84LOW

67

Sunday, April 12 , 2015 www.ocala.com $2.00

SUNDAY $300UP TO

INSIDE

IN COUPONSAVINGS

Cities oppose pension bill they believe favors unions

BRUCE ACKERMAN/STAFF PHOTOGRAPHER

The Institute of Cardiovascular Excellence is shown near the Market Street at Heath Brook shopping center on State Road 200 in Ocala on Thursday.

Pricey procedures lead to outsized Medicare payoutArea cardiologist frequently performs treatments others rarely do

Fla. parties fl ush with money from interest groupsWith their gambling deal set to expire, the Seminole Tribe is among key donors this year.

OBAMA, CASTRO VOW TO TURN THE PAGE, 3A

HUNDREDS JOIN VIGIL FOR FALLEN OFFICER, 1B

A comparison of the 10 cardiologists in the United States who received the most Medicare payments in 2012 to the number of patients for whom the provider charged the national program. Shown in the graphic below, Dr. Asad Qamar received the most Medicare payments of any cardiologist in the country while seeing a comparatively similar number of patients as the other doctors.

ROB MACK/Staff graphicSOURCE: Centers for Medicare & Medicaid Services

Top 10 cardiologist Medicare-payment recipients and number of patients

$4.5 M

1,662

#2Ashish Pal

Davenport, Fla.

$3.68 M

1,374

#3Kusai Aziz

Visalia, Calif.

$3.52 M

3,102

#4Shashi SharmaVisalia, Calif.

$3.44 M

753

#5Nagender Reddy

Ocala

$3.35 M

4,390

#6Rajen ManiarFlushing, N.Y.

$3.32 M

1,713

#7Vinod Kumar

Bakersfield, Calif.

$2.73 M

2,250

#8David LewLeesburg

$2.73 M

2,321

#9Klaus RentropNew York, N.Y.

$2.63 M

2,321

#10Parag Doshi

Schaumburg, Ill.

$18.2 M

1,798

#1Asad Qamar

Ocala

Payments Medicare patients

YOUTUBE.COM

Dr. Asad Qamar of the Institute of Cardiovascular Excellence is shown in a still from a YouTube video he prepared in his defense.

By Zac AndersonHalifax Media Services

Many cities across Florida have serious pension problems, with roughly $10.5 billion in unfunded liabilities spread across 491 municipal plans. Some cities have been raising taxes in recent years to keep up with the costs.

State lawmakers say they want to help, but in an unusual twist, city leaders are accusing the Republican-controlled Legislature of favoring unions over local taxpayers and supporting legislation that would actually make it more diffi cult for cities to reduce their pension liabili-ties and cut benefi ts.

The local pension bills are pitting cities against police and fi re unions, which historically have held signifi cant sway over Republican lawmak-ers.

The unions are unhappy with how Gov. Rick Scott’s administration has interpreted state pension law. They are strongly supporting a bill that advanced in the House this week — and similar legislation moving quickly through the Senate — that provides new rules for dividing state funds allocated for police and fi re pensions.

City offi cials say the legislation would limit their ability to drive hard bargains with unions.

Know the symptoms of a heartattack and trust Ocala Healthfor your emergency needs.

Ocala Regional Medical CenterWest Marion Community Hospital

Text ER to 23000 for ER Wait Times

Online at Ocala.comTo see a database of Medicare ■

payments for 2012, visit www.ocala.com/medicare

INSIDE TODAY: SUMMER PLANNERA comprehensive parents’ guide to area summer camps and activities, summer-long entertainment and more.

a.coommmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmm mmmmmmmmmmmmmmm m mmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmm mmmmmmmmmmmmm

R

Coming Monday

Patients ■

express admiration for Dr. Qamar, but he also faces two whistle-blower lawsuits.

QAMAR on Page 6A

FUNDRAISING on Page 10A

PENSIONS on Page 10A

Page 2: Pricey procedures lead to outsized Medicare payoutcdn.gatehousemedia.com/custom-systems/ghns/files... · $3.44 M 753 #5 Nagender Reddy Ocala $3.35 M 4,390 #6 Rajen Maniar Flushing,

Qamar declined to grant an interview for this story. His representative said the Medicare reimbursement amount is high because it accounts not just for Qamar’s work, but also the work of several other doctors who practiced at Qamar’s Institute for Cardiovascular Excel-lence and billed under Qamar’s Medicare billing number. The practice, known as ICE, has offi ces in Marion, Lake, Sumter and Levy counties.

The Star-Banner asked for, but was not given, a list of doctors whose work would have been counted under Qamar’s billing number. Some of ICE’s current doctors, with ICE bios showing they worked for Qamar during 2012, billed under their own numbers, the Medicare data show. In addition, the federal government strictly limits when doctors can bill under another doctor’s Medicare billing number.

The average total Medicare reimbursement for cardiologists nation-ally in 2012 was $167,063. In Florida, the average reimbursement for cardiologists was $260,199. Medicare reimbursed Qamar $18.2 million.

Medicare reimbursed Qamar an average of $10,097 per patient. Other Ocala–area cardio-inter-ventionists received anywhere from a few hundred dollars to about $1,700 per patient.

Nearly $13 million of Medicare’s $18.2 million payment to Qamar in 2012 stemmed from four procedure codes, each of which has its own Medi-care identifi cation number.

Two of the four codes involve a combination of clearing vascular block-ages by trying to cut or scrape the blood vessel clean, performing an angioplasty (using a balloon to open the vessel) and installing a stent. Of those two codes, one is performed on vessels above the knee and one on vessels below the knee.

The other two Medicare codes involve the same procedures but without the stents. Again, one is performed above the knee and the other below.

Procedures below the knee can be more complex because the blood vessels are signifi cantly smaller than those in the thigh. The average Medicare reimbursement for the four procedures ranges from $7,621 to $11,844.

During 2012, Qamar performed 1,331 of these four procedures on 935 Medicare patients, indicat-ing that some of the patients were repeat customers.

Qamar in 2012 had the highest Medicare reim-bursement amounts nationwide for three of those four procedures.

Code 37231 is the below-the-knee procedure that involves clearing vascular blockages by cutting or scraping the blood vessel clean, performing an angio-plasty and installing a stent.

In 2012, 553 of those were performed nationally — 74 percent of them by Qamar, according to Medicare data. The Medicare reimbursement rate for the procedure averaged $9,678.56. He was reimbursed nearly $4 million from Medicare.

When the same proce-dure is performed above the knee, the Medicare code is 37227. There were 5,350 of those performed

nationally in 2012, and Qamar performed 565, or 10.6 percent. That was three times as many as the next closest doctor.

That procedure paid an average of $11,844.23. Medicare reimbursed him nearly $6.7 million.

When the same proce-dures are performed with no stent placement, Qamar’s numbers drop. So does the reimburse-ment rate.

The same procedure performed without the stent and above the knee is known as Code 37225. Qamar accounted for fewer than 1 percent of the 13,791 performed nation-ally. That procedure paid an average of $7,620.90. He was reimbursed more than $860,000.

The same procedure, without the stent and below the knee, is billed under Code 37229.

Qamar accounted for nearly 3 percent of the 8,406 performed nation-ally. That procedure paid $5,871.31. He was reim-bursed more than $1.4 million.

“I think they are crazy numbers,” Schneider said. “We probably do 300 below-the-knee proce-dures by all four doctors.”

Qamar did more than double that on his own.

Of all the procedures Schneider’s group performed, 25 peripheral procedures a year involve atherectomies, which entails a doctor scraping/cutting away plaque in the vessels.

All of Qamar’s four highest-priced procedures included atherectomies. There were more than 1,300.

“There’s no possible way this number of procedures should be done in any practice,” Schneider said.

Schneider said it is easy to approach the Medicare system in such a way that reimbursements could add up quickly.

When performing a peripheral revasculariza-tion, fi rst perform an atherectomy. The doctor gets reimbursed regard-less of whether it works.

Then perform an angioplasty to open the blockage and put in a stent to try and keep it open, he said.

Then submit the bill.Schneider noted that

stents below the knee often fi ll in again. That means the patient could end up right back where he or she started.

Lou Colasuonno, senior managing director of Strategic Communica-tions, a Washington, D.C., consulting fi rm that Qamar hired, said his client has done nothing wrong, and a deeper look at the numbers will prove it.

“There’s a lot of context missing” from that $18.2 million, he said.

He elaborated in a statement issued Friday: “The $18.2 million attributed to Dr. Qamar’s 2012 Medicare billings was for procedures performed across the seven ICE facilities by the medical teams of doctors, physician assistants and advanced registered nurse practitioners. As reported by Medicare, nearly 90 percent of that $18.2 million — or $16.2 million — was dedicated to overhead and expenses.”

Separately, Colasuonno said the public should remember how much Qamar has saved Medi-care by performing procedures in his facility as opposed to a hospital, where care is more expensive.

■ ■ ■

Qamar attended medical school at the University of

Punjab in Lahore, Paki-stan, and served his internship at Services Hospital, which is affi li-ated with the university. Qamar than performed internships at various hospitals and health care facilities in Pakistan.

In 1991 he began his one-year internship in internal medicine at Bridgeport Hospital in New Haven, Connecticut, followed by a two-year residency program. He followed that with a fellowship in cardiovascu-lar diseases at the same hospital, according to court records.

He is board certifi ed in internal medicine and cardiovascular diseases.

In 1997 he moved to Ocala and worked for the Marion Cardiovascular Institute in Ocala. Three years later he joined the Central Florida Heart Center. In 2008, Qamar and three other cardiolo-gists founded the Institute of Cardiovascular Medi-cine in Ocala.

One year later, the owners had a business dispute and two partners sued Qamar, claiming he undermined the business by hiring away many of the employees and enrolling their shared patients in his newly established Institute of Cardiovascular Excel-lence on State Road 200, according to court records. The lawsuit was eventually settled.

Soon after, SunTrust Bank, which held the mortgage on the Institute of Cardiovascular Medi-cine, foreclosed on the owners. Qamar bought the debt from the bank and eventually the business.

■ ■ ■

Qamar’s rise did not happen in a vacuum. He and his business thrived in a medical environment that is still rapidly chang-ing, and where the number of vascular procedures outside the heart are skyrocketing.

The number of proce-dures performed to open blockages in heart vessels fell by about 30 percent from 2005 to 2013, to about 323,000 for patients covered under Medicare.

During the same period the number of similar procedures for vessels outside the heart rose by almost 70 percent, to 853,000, according to a New York Times analysis of data collected by Advisory Board Co., an analytics and research fi rm that analyzed Medicare payment data.

Dr. Rakesh Prashad is director of the Central Florida Heart Center’s catheterization laboratory and also the director of Ocala Regional Medical Center’s cath lab.

To understand why so many peripheral vascular procedures are being performed by some doctors, Prashad said, it is important to understand the history and context.

He is a cardiologist and is board certifi ed in internal medicine, cardiovascular disease and interventional cardiology, which focuses on the kinds of procedures at issue with Qamar.

Prashad said that, until about 15 years ago, most of the attention when it

came to blocked blood vessels was directed toward the heart and the blood fl ow in and out of that organ.

By 2000, that started to change. Cardiologists began seeing that signs of problems in the vessels outside the heart, namely the legs, were also an indication of problems in the entire circulatory system, he said.

There were many similarities in the symp-toms, too. When a patient has obstructed arteries, he or she can have symptoms such as pain, Prashad said. In the heart, those symptoms are angina, or chest pain, from lack of oxygen to the heart. And in the legs, those blockages can also result in pain, even debilitating pain.

As doctors became more familiar with outside-of-the heart blockages and started treating them, Medicare took notice.

Eventually, doctors were diagnosing more and more peripheral arterial disease and treating it, whether by noninvasive means or by invasive means such as angio-plasties and stents, as opposed to surgery, Prashad said.

Medicare also noted that those diagnoses and treatments were mostly being done in hospitals, where care is not cheap.

Peripheral arterial disease was always there, but the attention was previously almost always on the heart and coronary disease, Prashad said.

Then doctors started understanding that when you had peripheral arterial disease “then you were also at increased risk of heart attacks and strokes and possibly losing your leg. It told us that when you had peripheral arterial disease that was a marker of risk for bad things to happen … (such as) strokes, heart attack or limb loss,” Prashad said.

The problem was the cost. Many of those procedures were still being done in hospitals. The federal Centers for Medicare and Medicaid Services, or CMS, said it had to do something to keep Medicare reimburse-ments for those kinds of procedures under control.

So, in 2008, CMS announced it was increas-ing its reimbursement rates to cath labs doing peripheral revasculariza-tion interventions. The hope was that the addi-tional money would be an incentive for those medical facilities to do a greater share of the procedures. Even with the higher reimbursements, it was still less than what hospitals were charging.

“The hope was, if you … make it benefi cial for someone to do it on an outpatient basis at a lesser cost than the hospital, you could save CMS money,

and it did initially work. ... It was less costly to be done on an outpatient basis,” Prashad said.

This changing environ-ment allowed doctors like Qamar to fl ourish.

CMS was now allowing stand-alone cath labs to diagnose and treat peripheral arterial disease at new, higher reimburse-ment rates. At the same time there was more awareness of the disease, better noninvasive imaging to diagnose the disease, and better medications to treat it.

At the same time, manufactures of medical devices were turning out smaller and better medically coated stents and delivery systems that allowed cardio-interven-tionists to treat those blocked vessels easier and in new areas of the leg, such as below the knee.

All of that combined caused the number of diagnostic and interven-tional procedures to skyrocket, Prashad said.

“The below-the-knee (procedures), where the

prolifera-tion is, where the billing is high, years ago would have been off limits. You had to be really hard pressed to fi x them,” he said.

“Even today, the indications for fi xing the below-the-knee vessels

would be rest pain, tissue loss. Then we’ll consider going below the knee,” Prashad said.

Decades ago, heart procedures saw a similar proliferation. When angioplasties fi rst came on the scene cardiologists thought that ballooning blocked blood vessels of the heart was practically a cure-all for blockages, Prashad said.

But over time, cardiolo-gists learned that angio-plasties were not always the answer for heart disease. Sometimes it was best to treat it with medicines, change the patients’ diet and get them on an exercise regimen.

In the same way, some interventionists are slowly beginning to see the benefi ts that doing procedures (in the legs) do not necessarily mean better outcomes than if medications had been used, Prashad said.

“(But) it took us four decades to understand the benefi ts and risks of coronary intervention versus leaving the disease alone or (using medicines). So now we are seeing a decrease in coronary procedures,” Prashad said.

As for cardiologists agreeing on when to intervene in vessels outside the heart, espe-cially in the legs, and when not to, “(that) is in its infancy,” Prashad said.

There was a reduction in heart procedures “be-cause we started policing ourselves. (Medical) trials started to come out,” he said.

Those trials showed that optimally medicated patients performed as well as patients who had interventional procedures performed on them, he said.

“(But) we’re not at the same level of (knowledge) as we are with the heart now. We still have cow-boys who see 90 percent blockage and fi x it,” he said.

“We need to police ourselves. We need to understand the literature. We need to understand the appropriate use of the technology … and if we can’t do that, then some-body else will police us, and it will be Medicare,” Prashad said.

Cardiologists who stick out because they do so many more procedures than other doctors are “going to get scrutinized by their peers, they’re going to be scrutinized by the billers, the payers, the insurance companies. … They’re going to be scrutinized because it’s all about appropriate costs and effective care,” Prashad said.

As for Qamar’s high numbers, Prashad said, “I’m not saying he is a cowboy, that these cases are inappropriate. They may be. But I think, rightfully so, it’s a red fl ag.”

Prashad said his Central Florida Health Center performs about 200 peripheral vascular diagnostic procedures in total annually and about 50 actual peripheral interventions in total.

Prashad’s Medicare reimbursement average in 2012 was $688 per patient, and he collected a total of $599,377 in Medicare reimbursements, similar to most other cardio-inter-ventionists in town.

Unlike Qamar, most of Prashad’s Medicare charges were for noninva-sive procedures.

What can patients do?Look for board certifi ed

doctors in the specialty of peripheral intervention, Prashad said.

“And they should not be afraid of getting a second opinion,” Prashad said.

Schneider agrees patients should not hesitate to get a second opinion. But he disagrees that there are not enough guidelines about when a peripheral vascular procedure should be performed.

“There are published society guidelines,” Schneider said.

Much of the problem is a lack of oversight at stand-alone cath labs, he said.

Although performing the procedures in a hospital cath lab is more expen-sive, there are at least a few more regulatory eyes watching what happens there and what the medical outcomes are, he said.

As for stand-alone, privately owned cath labs, “there is no formal oversight at all,” he said. “There’s no national or state reporting. … That’s why it’s a little bit of the wild west” when it comes to peripheral procedures.

Out-patient revascular-ization “is much more lucrative, (and many doctors) took advantage of the increased reimburse-ment,” he said.

Some peripheral vascu-lar procedures have even doubled in the past couple of years, he said.

CMS is aware of the growing numbers. As for how to curb that growth, Schneider said CMS might reduce reimbursements across the board for these kinds of procedures if they don’t decrease. Another possibility is a lot more scrutiny when they stick out with high numbers.

“Meanwhile,” he said, “we all pay at the end.”

Star-Banner systems analyst Jim Trebilcock and the Sarasota Herald-Tribune’s Maggie Clark contributed to this report. Contact Fred Hiers at [email protected] or 867-4157.

QAMAR: Says reimbursement total includes other doctors in practice

“I’m not saying he is a cowboy, that these cases are inappropriate. They may be. But I think, rightfully so, it’s a red fl ag.”

DR. RAKESH PRASHAD, director of the Central Florida Heart

Center’s catheterization laboratory, on the high number

of certain cardiovascular procedures performed by

Dr. Asad U. Qamar

Leader in the fi eldTop providers of a below-the-knee procedure that involves

clearing vascular blockages by cutting or scraping the blood vessel clean, performing an angioplasty and installing a stent.Provider Location Patients ProceduresAsad U. Qamar Ocala 313 408Russel C. Lam Dallas, TX 41 53David E. Allie Lafayette, LA 42 44William D. Suval Victorville, CA 33 36Rajesh M. Dave Camp Hill, PA 12 12

SOURCE: Centers for Medicare & Medicaid Services

Continued from 1A

6 A | OCALA STAR-BANNER | SUNDAY , APRIL 12 , 2015 www.ocala.com

Page 3: Pricey procedures lead to outsized Medicare payoutcdn.gatehousemedia.com/custom-systems/ghns/files... · $3.44 M 753 #5 Nagender Reddy Ocala $3.35 M 4,390 #6 Rajen Maniar Flushing,

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Final reportThere will be a ticket, but no charges, in the two-vehicle traf-fi c crash in July that killed an 8-year-old boy. B1

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2 FESTIVALS SATURDAY IN DUNNELLONGO

Thursday, October 15, 2015

By Fred Hiers Staff writer 

Although he denies it, state records suggest that local hote-lier Danny Gaekwad funded a political group’s advertising blitz against Mayor Kent Guinn during the waning days of the recent election season.

On Sept. 4, just 11 days before the Ocala mayoral election, a company called NDS  USA LLC gave the Small Business

Advocacy Council $7,500, according to records on file with the Florida Division of Elections. It was the only contribution the organization has received since October 2014.

In the following days, state records show, that organization spent $6,766.50 on an adver-tisement in the Star-Banner, mailers, and telephone services. The mailers and ad focused on Guinn’s former problems with property taxes and federal

taxes. It was the first substan-tial spending the group had done since October 2014.

Gaekwad is the registered agent for, and one of the oper-ating managers of, NDS  USA LLC, according to the Florida Division of Corporations. The company, self-described as an “IT enterprise,”  lists the address of an Ocala home that the Gaekwad family owns.

The Small Business Advocacy Council is an electioneering communications organization based in Tallahassee. Its latest state-required finance report

covers the period of Sept. 1-30.The report wasn’t availableimmediately after the electionor in the following days, whenthe Star-Banner researched astory about the campaign.

Repeated phone calls to theSmall Business Advocacy Coun-cil went unreturned. Accordingto its campaign finance reports,the group spends its money onmailers and TV ads.

Gaekwad did answer the Star-Banner’s phone call. At first hepleaded ignorance when asked

OCALA ELECTION

Gaekwad gave to anti-Guinn groupAds slammed incumbent mayor

Israeli army begins deploying troopsHundreds of soldiers fanned out in cities across Israel on Wednesday and authorities erected concrete barriers outside some Arab neighbor-hoods of east Jerusalem in a stepped up effort to counter a monthlong wave of Palestin-ian violence that has seen near daily attacks. . A3

Police: Boys beaten for confessionTwo teenage brothers were brutally beaten in church — one fatally — in an effort by their parents, sister and other mem-bers to get them to confess their sins, police said Wednes-day in a case involving an insular congregation that had sparked gossip and suspicion among neighbors. A3

SPORTS

Bad week gets worseFlorida suspended cornerback Deiondre Porter from the team indefi nitely Wednesday fol-lowing his arrest earlier in the morning on aggravated battery and aggravated assault with a deadly weapon. C1

LIFE

Cruising America’s inland seasThe Great Lakes are a great place to cruise. D1

Mike Kaufman, left, and Jerry Murphy look over plans for their Tavilla IV model home as they prepare the models for the upcoming 2015 Marion County Building Industry Association Parade of Homes. Area builders will show 20 homes in all price ranges. ALAN YOUNGBLOOD/STAFF PHOTOGRAPHER

By Richard AnguianoBusiness editor

What the Marion County Building Industry Association had been calling its Fall Show-case of Homes opens today with a new, albeit familiar, title.

MCBIA now calls the event, which runs through Sunday, the “Fall Parade of Homes,” borrowing from the organiza-tion’s larger showcase held each year in the spring.

Dave Harden, MCBIA execu-tive officer, said the renaming is for the sake of continuity.

“This year, I said, ‘You know what? So the public identifies it’s one and the same group providing this service, let’s keep (the name) identical,’” Harden said.

This event is to feature 19 homes by 14 builders. Last year's event displayed 16

Showcase starts todayFALL PARADE OF HOMES

19 homes from 14 builders If you goWHAT: 2015 Fall Parade of HomesWHEN: Models open noon to 5 p.m., today through SundayWHERE: Various locations throughout Marion County.SPONSOR: Marion County Building Industry AssociationPHONE 352-694-4133WEBSITE: http://mcbia.org/MAP: To see a map of the home locations, click on this story at ocala.com

By Cindy SwirkoStaff writer

A task force to study the safety and reliability of Inter-state 75, and provide relief for cars and trucks, has been formed by the Florida Depart-ment of Transportation.

Among those named to the panel from Alachua County are County Commissioner Chuck Chestnut, Hawthorne Mayor Matt Surrency and Jane Adams, University of Florida vice presi-dent for university relations.

Marion County members are

County Commissioner Stan McClain and Kevin T. Sheilley, president and CEO of the Ocala/Marion County Chamber and Economic Partnership.

Levy County Commissioner John Meeks is also on the panel.

“They are trying to look at how they can get some of the congestion ... off I-75. Where the interstate and the Turn-pike come together, you have a higher number of accidents than would typically be cre-ated,” said Surrency, who is also on the Florida Transporta-tion Steering Committee for the

Florida League of Cities.The task force is part of an

FDOT planning process for the future of the state’s major

transportation corridors over the next 50 years.

A task force goal will be to

INTERSTATE 75 CONGESTION

Area offi cials tapped for transportation task forceOfficials work the scene of a crash involving two cars and the semi in the northbound lanes of Interstate 75 near the Millhop-per Road overpasss on Sept. 17, 2014. DOUG FINGER/STAFF

PHOTOGRAPHER

SEE HOMES, A7

SEE TRAFFIC, A7

By Christopher CurryStaff writer

Tax cuts, health care fund-ing, guns and water policyloom large when the  2016legislative session starts inJanuary.

Declaring 2016 “the yearof the manufacturer,” Gov.Rick Scott told reporters atthe annual Associated Presspre-session media day that hewould push for tax reductionsthat surpass last year’s $400million in cuts, additionalfunding for Enterprise Flor-ida to woo businesses to thestate and make permanentthe manufacturing industry’ssales tax exemption on equip-ment purchases.

Pointing to an averageof 250,000 new jobs eachyear, Scott said “we’re on aroll” and said more growthin manufacturing will help“diversify our economy.”

Florida Senate MinorityLeader Arthenia Joyner, astate senator and Democratfrom Tampa, offered a differ-ent point of view. Declaring it“just another day in Tallahas-see,” Joyner criticized Scottand GOP leaders for rejectingMedicaid expansion to make a“political statement” against

LEGISLATIVE PREVIEW

Issues: Tax cuts, healthcare, guns and water

SEE ISSUES, A7

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Ocala Star-Banner | www.ocala.com | Thursday, October 15, 2015 A7

about the timing of his company’s contribution and the anti-Guinn blitz. He said he knew nothing about the contribution or the Small Business Advo-cacy Council.

When told that NDS USA LLC was the donor, and that he is the company’s registered agent and oper-ating manager, Gaekwad acknowledged that NDS was, in fact, his company. But he said he makes many contributions to many organizations.

“I have no control over what they do. They do what they want,” he said.

Asked why he didn’t make the contribution under his own name, but instead through NDS, Gaekwad said he often makes contributions or spends money through his various companies.

He would not say spe-cifically why he made the contribution to the Small Business Advocacy Coun-cil or what he expected in return. He said only that he didn’t tell the group how to spend the money.

He said he has no dis-agreements with Guinn and that if he did, he would have addressed them with-out any help.

“Why do I need a third party when I could do it myself?” Gaekwad asked, adding later, “If I had a bone (to pick with the mayor), I’d have come to the paper (and put an ad in). I’m not afraid of anybody.”

Gaekwad said it wouldn’t be right to associate him with the Small Business Advocacy Council’s efforts against Guinn.

“I give to the Humane Society. Are you going to blame me if they kill a dog?” he asked.

G u i n n w a s n o t

surprised by the Gaekwad connection.

The mayor said the hotelier likely funded the negative ads because he (the mayor) could not be pressured by the wealthy and influential businessman.

“I just think he wanted someone who wouldn’t question him (about his hotel project),” Guinn said. “(He wanted) some-one who would just roll over.”

Guinn, the incumbent, prevailed in the elec-tion, easily getting past Billy Gilchrist. Although Gilchrist had issued a hard-hitting piece of his own against Guinn, the challenger said he had nothing to do with the Small Business Advocacy Council’s ads. By law, such groups can’t coordi-nate ads with candidates. Gilchrist did not return telephone calls for this story.

Guinn supports a down-town hotel and favors providing some city sub-sidies to make it happen.

Gaekwad’s hotel design proposal will be the only one presented to City Council on Nov. 3. Devel-oper Albert Peek had also submitted a hotel deal to city staff but he pulled his plans out of the running late in the negotiating pro-cess, leaving Gaekwad’s proposal the only one remaining.

Guinn said that although as mayor he isn’t allowed a vote on the hotel pro-posal, he still can discuss the issue and point out any design shortcomings.

Guinn said he wants Gaekwad to build the hotel, but that the design must be compatible with historic downtown.

“I just don’t understand why he (Gaekwad) did that other than I was someone who would stand up to him,” he said.

Guinn said he would bevoicing his concerns thatthe proposed hotel designneeded some architecturalchanges to make it morein line with surroundingbuildings.

City staff has recom-mended that the councilapprove Gaekwad’s $15.7million proposal to build a90-room hotel, retail andtownhouse complex onthe previous chamber ofcommerce site, east of thedowntown square.

Gaekwad owns sev-eral businesses and localhotels including a Holi-day Inn, Holiday InnExpress, Hampton Inn,Carlson Hotels CountryInn and Suites, and SkyAsian Fusion restaurant.He has also been active onseveral boards and localcharitable organizationsincluding the United Wayin Marion County and is aboard member of Enter-prise Florida.

Two earlier instances,not tied to Gaekwad,show the Small BusinessAdvocacy Council's tac-tics. In 2012, the councilpaid for mailers discred-iting incumbent CollierCounty CommissionerTom Henning. The mailersalleged he had been violenttoward both his wives. The“charges” of domestic vio-lence turned out to be civilallegations and not crimi-nal, according to a newsaccount of that campaign.

In 2011, the group paidfor mailers attackingAltamonte Springs incum-bent Mayor Pat Bates,according to a separatenews account. Bates ranagainst CSX Transporta-tion lobbyist Bob O'Malley.The mailers accused Batesof being a liberal Demo-crat who supported raisinglocal gas taxes.

—Reach Fred Hiers at [email protected] and 867-4157.

 

ADSFrom Page A1

models. A promotional flyer indicates prices this year range from $149,500 for the “Merganser,” by KAP Design Group, in Orange Blossom Hills at 9424 SE 163rd St., to $999,698 for the “Lang-don,” by Golden Ocala Golf & Equestrian Club, in The Brittany at 3272 NW 77th Ave.

“A lot of young, first-time homebuyers are coming into the market who are anxious to have their own home for the first time,” Harden said. “Some of these homes in the parade are entry-level homes, where first-time homebuyers could certainly consider a design, a foot-print and square footage to accommodate their needs.”

Meanwhile, the name change isn’t the only new wrinkle this year: For the first time, a “community entry” is part of the Parade: Legendary Trails by Arthur Rutenberg Homes, at 2505 SE 80th St.

“It’s a little something different,” Harden said. “A lot of times folks will say, ‘Let’s go look for a lot first before we pick a builder.’ You look at the neighborhood, you look

at the district, you look at the roads and recreational facilities nearby. Legendary Trails is in close proximity to the Florida Greenway.

“Now that the hous-ing market is starting its recovery in Marion County, we thought it an oppor-tune time to let the public know that there are a great many developed vacant lots available for home construction,” he said. “I thought that would be one of the best ways to demon-strate the availability, by having community entries in the Parade of Homes.”

Mike Kaufman, co-owner of Murphy Kaufman Builders, said his company is “really excited” about its three entries in this year’s event.

“ W e ’ v e g o t s o m e updated, modern plans for people to come and enjoy,” Kaufman said. “We’ve been told inventories are really low out there on used homes and we see a bright future in new home construction.”

Tim Petty, a home sales consultant for Armstrong Homes in Bellechase, said his company encouraged MCBIA to revive the fall event, which the organiza-tion did not stage for several years after the economic downturn.

“Every year the economy

keeps getting better and Ocala/Marion County keeps doing things to attract more people here,” Petty said. “Our business keeps growing, so we’re very excited and we love to keep showing off our houses.”

Harden suggests attend-ees keep in mind that the event last four days and homes on display are grouped, more or less, into quadrants.

“They might find it more convenient to stay in one quadrant to start with,” he said. “That way, they’re not hopscotching around the county. They can visit the homes in a logical, sequen-tial manner and see as much as they can see in that time period.”

— Contact Richard Anguiano at [email protected]

 

HOMESFrom Page A1

Osuely Mendez touches up the master bath in an Armstrong Homes Gracie model. ALAN

YOUNG-

BLOOD/

STAFF

PHOTOG-

RAPHER

The master bath in Mike Kaufman and Jerry Murphy’s Tavilla IV model home.

the Affordable Care Act and leaving millions uninsured.

She chastised them for violating the Fair Districts amendment — “violating the very Constitution that they swore on a Bible to uphold” — leading to a series of special ses-sions on congressional and Florida Senate redistricting.

She decried the tax incentives Scott wants increased funding for as “corporate welfare” and said much of the job growth the governor touts are low-paying jobs, while GOP lead-ers reject efforts to substantially increase the minimum wage. And she chided Republican lawmakers for pushing issues such as guns on college campuses that do “next to nothing” for most Florida citizens.

Looking ahead, Senate President Andy Gar-diner, R-Orlando, and House Speaker Steve Crisafulli, R-Merritt Island, both said addi-tional tax cuts would be on the table this year. Striking a more cau-tious tone than Scott, Gardiner said $250 million would be the Senate starting point. He noted that the talk of increased cuts comes with a projected surplus of $630 million, but only $200 million of that is expected to be recurring.

“We want measur-able goals and examples where we can see yes, this tax cut works,” Gar-diner said.

Earlier this year, a special session on budget issues and health care funding ended in acri-mony, after Scott and the House rejected a Senate plan that would use federal Medicaid expansion monies to give the poor financial assistance to buy pri-vate health insurance and require adults who are not disabled to either work, go to school or get job training and pay monthly premiums.

Crisafulli said health c a r e a c c e s s w o u l d again be an issue but said the House remains “steadfastly opposed to expanding Medicaid under Obamacare.”

He said they would instead look for “free market” solutions that use “innovation.” Some measures last session that passed the House but did not make it through the Senate

included eliminating the certificate of need process for hospital con-struction, expanding the prescribing authority of nurse practitioners and the use of telemedicine, promoting direct pri-mary care practices that take insurance compa-nies out of the equation and allowing overnight stays at ambulatory sur-gery centers.

Gardiner said law-makers “have to be careful” not to make priorities out of “sec-ond-tier proposals” that may be innovative but don’t address problems with uncompensated care and a lack of health care coverage.

“If you don’t have insurance, it doesn’t matter how many new programs you create, you’re still not going to have access.”

Scott said every family “has to have quality health care they can afford.”

He pointed to the committee he has formed on hospital funding and said he wants more transparency from hos-pitals on costs and “more competition.”

He criticized the Obama administration for saying it cares about health care for poor people and then reducing funding for and even-tually phasing out the low-income pool, or LIP, that compensates hospi-tals with high numbers of uninsured patients.

But when the federal government granted a waiver in 2014 to fund LIP for one more year, instead of the three years the state sought, federal officials indicated they planned to stop funding the LIP.

Centers for Medicare and Medicaid Services officials said they wanted the state, which also has a federal waiver for a managed care Medic-aid system that relies on private insurers, to develop “sustainable, transparent, equitable, appropriate, account-able and actuarially sound Medicaid payment systems and funding mechanisms that will ensure quality health care services to Florida’s Medicaid beneficiaries throughout the state

without the need for Low Income Pool (LIP) funding.”

Gardiner and Crisafulli both said they expect the 2016 session to produce “comprehensive” water policy after failed efforts in 2014 and 2015.

Crisafulli said he expects the bill the House passed to be the starting point, but many environmental groups felt it did little to noth-ing to protect the state’s springs and rivers.

With bills filed to allow people with concealed weapons permits to carry on campus, into public meetings at the Capi-tol and to carry openly, Scott sidestepped ques-tions on guns multiple times.

He said he supports the Second Amendment “but I haven’t seen the bills.” Asked if he sup-ports guns on campus, he again said he hadn't seen the proposed legislation.

Gardiner said his committee chairs have discretion on which gun bills are heard and any gun bill that makes it through committee will go to the full Senate to “vote it up or down.”

Crisafulli also would not come down on either side on the gun bills, saying any legisla-tion “will certainly have an opportunity to be vetted.”

Joyner was clear in her position.

“ W h e n y o u m i x young people and edu-cation with drugs, with sex, with frivolity and youthfulness and guns, then you create a situa-tion that could result in untold injury and death.”

Despite special ses-sions on health care and redistricting that ended in acrimony, Gardiner and Crisafulli both said several times that they feel the two houses work well together on most issues.

Gardiner, who has a son with Down syn-drome, said increasing and improving educa-tional, job and residential opportunities for chil-dren and adults with “unique ability” will be a priority in his last session in the Senate. Crisafulli said working with Gar-diner on that is a priority for him, too. 

ISSUESFrom Page A1

provide recommenda-tions for developing new high-capacity corridors from the Tampa Bay area to Jacksonville, including I-75.

“Florida is the third-largest state in the nation with almost 100 million visitors each year,” FDOT Secretary Jim Boxold said in a press release. “Inter-state 75 is the primary g a t e w a y into Central Florida and Tampa Bay for visitors and commuters and one of the most traveled truck routes in the state; it’s critical to examine options to increase mobility and

safety in this region.”District FDOT spokes-

woman Gina Busscher provided average daily traf-fic counts for various points on I-75 for Alachua and Marion counties in 2014.

The busiest point in Alachua County was at N e w b e r r y R o a d w i t h 70,000 vehicles, followed by the Northwest 39th Avenue area with 68,500.

In Marion County, the area of State Road 200 averaged 80,753 vehicles a day, followed by U.S. 27 with 69,000.

South of the Turnpike in Sumter County, an average of 61,500 vehicles traveled daily on I-75.

FDOT officials said the first meeting of the task

force will be Dec. 7. Its workis expected to be completeand a report presented byOct. 1, 2016.

Meanwhile, a lot ofwork is planned for I-75in Marion and Alachuacounties.

Resurfacing has begunin Marion County and isplanned for Alachua.

And cameras and sensorshave been installed in Ala-chua County across PaynesPrairie Preserve State Parkin a major technology boostto try to prevent a repeat ofa series of crashes in Janu-ary 2012 in heavy smokeand fog that killed 11 andleft 20 more hospitalized.

Large dynamic mes-saging signs will also beinstalled.

TRAFFICFrom Page A1

“When you mix young people and education with drugs, with sex, with frivolity and youthfulness and guns, then you create a situation that could result in untold injury and death.”— Florida Senate Minority Leader Arthenia Joyner

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Business .......D1Calendar .......B2Classifi ed ......D5Comics ..........D4Crossword.....D2Lottery ..........A2

Obituaries .....B3Opinion .........B5Sports ...........C1 Sudoku..........D3 Television ......D3 Weather ........B6

NATION/WORL.D

LIFE

LOCAL

Headed for YaleVincent Vaughns, a young man from North Marion High School who earned $96,000 in scholar-ships and a fellowship at the prestigious Phillips Exeter Academy, has been accepted to Yale. B1

Marked improvementMarion County’s high school graduation rate is now higher than the state average. B1

Relatives question Chicago shootingsGrieving relatives and friends of two people shot and killed by Chicago police said Sunday the slayings raised concerns about why offi cers “shoot fi rst and ask questions later,” adding that law enforcement offi cials had failed the city’s residents. Quintonio LeGrier, 19, was killed early Saturday by police responding to a domestic disturbance, along with down-stairs neighbor Bettie Jones, 55, police said. Jones was hit accidentally by the gunfi re, the police said. Both victims were black. A3

Game changerTogether, Google and Ford plan to disrupt Detroit, D1

TODAY TUE WED

84°/67° 85°/67° 85°/66°

Complete forecast, B6

Volume73, Issue 90

0 390994 24006

Campaign 2016: Abortion likely to be hot issue NATION & WORLD, A4

ocala.starbanner @ocalastarbannerocala.com $1

FALCONS SPOILPANTHERS’ RUNAT PERFECTIONSPORTS, C1

Monday, December 28, 2015

By Joe Callahan Staff writer

Seven years ago, Marion County School Board members were concerned about the local graduation rate.

Unlike the high school dropout rate, which means students do not graduate at all, the graduation rate looks at the abil-ity of high school students to graduate on time, in four years from the time they start the ninth grade.

In the 2007-08 school year, Marion’s graduation rate was a dismal 54 percent, 8 percentage points below the state average.

Pushed by former board member Ron Crawford, the board made improving those numbers a top priority. Officials imme-diately implemented programs, such as online courses and summer remediation,

to help students improve Marion’s status.And the new programs have helped

Marion County catch up to — and pass — the state average. Marion’s rate has climbed four times faster than the national average and two times the state average since 2008-09.

In just six years, Marion County’s gradu-ation rate has risen by nearly 20 percentage points, from 58.4 percent in 2008-09 to 77.9 percent in 2013-14, according to state Department of Education data.

The state graduation rate rose from 65.5 in 2008-09 to 76.1 in 2013-14. Once far behind the state average, Marion now has a graduation rate that is nearly 2 percentage points higher than their statewide peers.

“We are above the state average for the

HIGHER THAN STATE AVERAGE

County grad rate improvesGraduation RatesGraduation rate is the percentage of stu-dents who start ninth grade and graduate in four years. Here’s how Marion compares with the state and national data for the last several years. Marion, which had one of the worst rates in Florida, now leads the state average by nearly 2 percentage points.

Year National State Marion2008-09 77 65.5 58.32009-10 78 69.0 62.82010-11 79 70.6 69.82011-12 80 74.5 75.22012-13 81 75.6 76.72013-14 82 76.1 77.9

Source: U.S. Department of Education, Florida Department of EducationSEE RATES, A6

By Fred HiersStaff writer

American Pharoah will have no say in how history judges him — but plenty of humans will.

The thoroughbred won the Triple Crown this year after 37 years of failed attempts and then won the Breeders’ Cup Classic. Now, it is up to horsemen and racing fans to decide where in the ledgers of thoroughbred racing history the colt should reside.

The task will not be easy. But racing fans are racing

fans, and people will judge the colt that proved the Triple Crown was not impossible in the modern era. To top off his career and prove he could beat older horses, and the best horses from around the world, he won the Breeders Cup Classic.

T h e T r i p l e C r o w n o f T h o r o u g h b r e d R a c i n g , often referred to simply as the Triple Crown, includes three races for 3-year-old thoroughbred horses. Win-ning all three of the races is considered a thoroughbred racehorse's greatest accom-plishment. The Triple Crown comprises the Kentucky Derby, the Preakness Stakes

and the Belmont. Since 1919, only 12 horses, including American Pharoah, have won the Triple Crown.

The Breeders’ Cup Clas-sic, which covers 1 ¼ miles, draws the top international thoroughbreds 3-years-old and older and is limited to 14 starters. With a $5 million purse, it is the richest race in North America.

“I’m a little close to this," said J.B. McKathan, who with his brother broke and trained

AMERICAN PHAROAH

Judging a Legacy

Triple Crown Winner American Pharoah ridden by Jockey Victor Espinoza gestures towards the crowd after win-ning the Breeders’ Cup Classic on Oct. 31 at the Keeneland Race Track in Lexington, KY during the second day of the 2015 Breeders’ Cup. Triple Crown Winner American Pharoah who was broken by J.B. McKathan of Marion County, ran his last race, the Breeders’ Cup Classic, before going out to stud. DOUG ENGLE/STAFF PHOTOGRAPHER

Ron Turcotte rides Secretariat on a practice run for the Belmont Stakes in 1973. AP PHOTO

Industry professionals weigh in on colt’s accomplishments, status in history

WHY IT MATTERSAmerican Pharoah, who was broken and trained in Marion County, had one of the best racing years of all time. Where does he rank among the great horses in his-tory? Such rankings, while unscientifi c, are a fun part of sports. Marion is Horse Capi-tal of the World, and fi guring out where Pharoah belongs will help the county as it continues pointing to the horse as one of our area's greatest success stories.SEE PHAROAH, A6

IS puts up heavy fi ght to slow Iraqis Islamic State fi ghters are putting up a tough fi ght in the militant-held city of Ramadi, slowing down the advance of Iraqi forces, a senior Iraqi commander said Sunday. Iraq launched the long-awaited operation to retake the Anbar provincial capital, which was captured by IS militants in May, but after an initial push across the Euphrates River, their prog-ress stalled. A3

By David Warren and Reese DunklinThe Associated Press

GARLAND, Texas — At least11 people died and dozens wereinjured in strong tornadoes thatswept through the Dallas areaand caused substantial damagethis weekend, while 12 peopledied in flooding in the Midwest.

It was the latest of a succes-sion of powerful weather eventsacross the country, from heavysnow in New Mexico, westTexas and the Oklahoma Pan-handle to flooding in parts ofthe Plains and Midwest. Daysof tumultuous weather haveled to 42 deaths overall — thosein Texas, plus five in Illinois,seven in Missouri and 19 in theSoutheast.

The full extent of damagefrom Saturday’s storms alonga nearly 40-mile stretch nearDallas came into clear focus.Local officials estimated asmany as 1,000 homes weredamaged or destroyed. Vehicles

SEVERE WEATHER

At least 11 die from Texas tornadoes

By Geir MoulsonThe Associated Press

BERLIN — For 70 years since the Nazi defeat in World War II, copyright law has been used in Germany to prohibit the publi-cation of “Mein Kampf” — the notorious anti-Semitic tome in which Adolf Hitler set out his ideology.

That will change next month when a new edition with criti-cal commentary, the product of several years’ work by a publicly funded institute, hits the shelves.

GERMANY

‘Mein Kampf’ returns to market in new form

A 1939-edition, right, and different other editions of Adolf Hitler’s “Mein Kampf” are on display at the Institute for Contemporary History on Dec. 11 in Munich. MATTHIAS BALK/DPA VIA AP

SEE HITLER, A5

SEE WEATHER, A5

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A6 Monday, December 28, 2015 | Ocala Star-Banner | www.ocala.com

third consecutive year,” School District spokesman Kevin Chris-tian said. “It has really come up substantially in the last decade.”

Christian said the graduation rate calculation is not flawless. He noted the rate is calculated by comparing the number of ninth-graders in a certain year to the number of graduates four years later. He said the data does not track each individual student and that many students leave the district and others enroll during that four-year span.

For example, if the district had a drop in enrollment during those four years, the rate could be lower than it actually is. In reverse, an influx in enrollment could show a better graduation rate than in reality.

The bottom line is, officials say, by and large the calculation is a good indicator of graduation rates.

While Marion’s rate rose by just shy of 20 percentage points since 2008-09, the U.S. grad-uation rate climbed by only 5 percentage points during that same time span, from 77 percent to 82 percent.

The U.S. Department of

Education reported that the national high school graduation rate of 82 percent in 2013-14 is the highest ever, according to data released by the agency’s National Center for Education Statistics.

The rate is at the highest level since states adopted a uniform way of calculating graduation rates five years ago.

U.S. Department of Education officials said districts have been using a common metric, called the adjusted cohort graduation rate, for the five years.

U.S. Secretary of Education Arne Duncan said in a press release that “the hard work of

teachers, administrators, stu-dents and their families has made these gains possible and as a result many more students will have a better chance of going to college, getting a good job, owning their own home, and supporting a family.”

For four consecutive years, graduation rates have climbed nationally.

U.S. Department of Education officials said improving gradua-tion rates is vital “to ensure the economic strength of our coun-try, students must graduate high school ready for college, careers and life.”

The department has invested

more than $1.5 billion in earlylearning and implementedstrategies to improve achieve-ment and close opportunitygaps.

“A high school diploma isabsolutely critical, absolutelyattainable and key to future suc-cess in college, in the workforceand in life,” said John King, thedepartment’s deputy secretary.“It is encouraging to see ourgraduation rate on the rise and Iapplaud the hard work we knowit takes to see this increase.—Joe Callahan can be reached at 867-4113 or at [email protected]. Follow him on Twitter @JoeOcalaNews.

RATESFrom Page A1

American Pharoah in Ocala. “I would say he’s the best of the modern era.”

The gold standard by which American Pharoah is measured are horses like Secretariat, Man o’ War and Citation.

Secretariat won the Triple Crown in 1973 and set three track records while doing so. Two of those records, set in the Kentucky Derby and the Belmont Stakes, still stand. He won the Belmont by a jaw-dropping 31 lengths.

In Secretariat’s day there was no Breeders’ Cup, so how he might have performed in that interna-tional race will never be known. By the time he was retired as a 3-year-old, he had raced 21 times and won 16 times. He finished out of the money only once, in his debut as a 2-year-old. He was jostled coming out of the gate and finished fourth.

Man o’ War raced for 16 months beginning in 1919. He raced 21 times and won 20 races. He won one race by an incredible 100 lengths. In another, he won car-rying a jockey who weighed 138 pounds, a weight unheard of today.

Man o' War did not race in the Kentucky Derby as his owner felt young 3-year-olds were not suited for the 1 ¼ mile race. Instead, he raced in the Preakness, and won, and the Belmont Stakes, winning that race by 20 lengths.

Man o' War's last race was against Sir Barton, who, in 1919, became the first horse to win the Kentucky Derby, Preakness and Belmont. At Kenilworth Park, in Windsor, Ontario, Man o' War beat the older horse by seven lengths.

Citation was the eighth horse to win the Triple Crown. He also was one of only three North American thoroughbreds to win at least 16 consecutive major stakes races and the first horse to win $1 mil-lion dollars in purses.

In comparison, American Phar-oah raced 11 times, winning all but two races. He won his last race, the Breeders’ Cup Classic, by 6 ½ lengths.

McKathan said even though champion horses before Ameri-can Pharoah raced more often and chalked up more wins, using that to rank his horse was unfair.

“He’s a product of his time (racing less frequently). So I would put him in that group (with Sec-retariat, Man o’ War, Citation). He danced every dance, he didn’t duck anybody,” McKathan said.

Mckathan also thinks that trying to differentiate the best handful of horses in history is like trying to split hairs.

“I believe he belongs at the table and once you’re at the table, the rest of it is just talk,” McKathan said. “Everyone has their favorite. I have mine.”

American Pharoah was bred and owned by Ahmed Zayat of Zayat Stables. The colt was trained by Bob Baffert. After winning the Breeders' Cup Classic, the horse was retired to stand at stud.

HOW GREAT?Among horsemen and racing

fans, there is little dispute that American Pharoah is a great horse. But how great?

“I would rank him in the top 20, but not top 10,” said Cindy Deubler, associate editor at Mid-Atlantic Thoroughbred.

He ran against good horses, the best the year could throw at him, she said, and his perfor-mance in the Breeders’ Cup “was spectacular.”

As for not setting more track records, Deubler said, “this horse did what he had to do” to win and if it didn’t require a track record, he shouldn’t be faulted.

Judging American Pharoah requires that you look at the long list of accomplishments of his betters, she said. And Amer-ican Pharoah doesn’t measure

up, she added.But in a decade or two, one

never knows, she said, his stand-ing may improve.

“(Top) 20 would still be very high in 10-20 years,” she said.

Frank Angst, a Blood-Horse staff writer, said American Phar-oah’s place in history belongs immediately behind Citation, but the the horse is certainly among the best racing has ever produced.

It’s not just the Triple Crown accomplishment that people need to remember, but also how well he continued to race afterward. Consider that the Triple Crown attempt for many horses marked the end of their careers, he said.

“He has an amazing ability to bounce back,” Angst said. ”I put his 3-year-old season up against anyone. A lot of horses struggled to bounce back after their Triple Crown campaigns.”

But to make comparisons is unfair, Angst said. The best he said he could do was to only put American Pharoah up against other Triple Crown winners.

“So, I’ll go War Admiral, Secre-tariat, Citation and then American Pharoah,” he said.

There are many who say Ameri-can Pharoah is overrated.

Retired jockey Jacinto Vasquez, who rode Kentucky Derby winner Foolish Pleasure and Fillies Triple Crown winner Ruffian, is not as generous in his praise of Ameri-can Pharoah.

“He was the best of this year. That’s all,” said Vasquez. “I knew a lot of great horses and some didn’t get the publicity they should have.”

“The best horses break track records. How many track records did American Pharoah break?” Vasquez added. ”And they make the tracks faster today too.”

“Affirmed, Seattle Slew, Dr. Fager. American Pharoah can’t compare. Only in the last 20 years he’s the best horse we’ve had,” Vasquez said.

Andrew Beyer agrees."Because the Triple Crown

has become such a difficult test for modern-day horses, Ameri-can Pharoah’s sweep was worthy of acclaim. But none of his three victories was, by itself, a superstar performance," said Andrew Beyer, Washington Post horse racing columnist and author. "Ameri-can Pharoah dominated a crop of

3-year-olds that was average at best. He won the Derby in a slow 2:03 (minutes). Secretariat’s time was 1:59.4 (minutes). Pharoah won the Belmont in 2:26.6 (min-utes); Secretariat won it in 2:24 (minutes). I cringe when com-mentators mention the two colts in the same breath."

"American Pharoah’s best claim to greatness was his victory in the Breeders’ Cup Classic. He faced the best older horses in the coun-try — always a definitive test for a 3-year-old — and dominated them," Beyer stated via email. "His fast time earned him a Beyer Speed Figure of 120, the best in any U.S. race at a mile or longer since 2005, and certified that he is an elite  racehorse. But in my opinion he doesn’t rank in the class of all-time greats such as Secretariat, Seattle Slew and Spectacular Bid."

But Ed DeRosa of Brisnet, an Internet horse racing information service which also analyzes racing times, said people should not put much stock in track records when trying to get the full picture of a horse.

“He is a Triple Crown cham-pion. I was of the belief that earned him the right to be mentioned in the same breath as the greats such as Secretariat, and others,” DeRosa said.

"Raw times don’t mean a whole lot. It’s not the be all, end all,” he added.

And American Pharoah, in the Breeders’, showed he could beat older horses while great 3-year-old horses such as Affirmed lost to older horse Seattle Slew and Spectacular Bid lost to older horse Affirmed, DeRosa said.

Should American Pharoah be considered the best or second-best race horse, pushing out Man o’ War and Secretariat from those spots?

“I don’t think he rose to that level,” DeRosa said, adding that the colt just didn’t race enough to warrant breaking that glass ceiling.

IT’S COMPLICATEDJay Privman of the Daily Racing

Form said it is complicated, in terms of ranking American Pharoah.

“There are only 12 Triple Crown winners. Whether he’s better than Secretariat or Seattle Slew, that’s hard to say,” Privman said.

But he belongs in the “pantheon of elites,” he said.

In 30 years, not much of his luster will fade and he will always be considered as one of the greats, Privman said.

Bill Giauque writes a racing column for the Star-Banner. Regardless of where American Pharoah ranks, “he does belong in the top tier,” he said. “He truly was a running machine.”

But horses like Secretariat became “supernatural” because of some of accomplishments such as his 31-length Belmont Stakes victory.

“I would put Secretariat, Man o’ War, Dr. Fager in one tier,” Giau-que said. “Citation, Spectacular Bid, American Pharoah in the next tier, at least right now. It’s hard to put a contemporary horse ahead of a legion.”

Lonny Powell, Florida Thor-oughbred Breeders' and Owners' Association CEO and executive vice president, said American Pharoah belongs among the best horses racing has ever produced.

“I believe he belongs in the club. I’m not saying he’s the chair or even the vice chair, but he belongs in the club,” Powell said. “He has his coffee poured out of the same coffee pot (used to serve Secre-tariat and Man o’ War).”

As for what thoroughbred train-ers think of American Pharoah, every trainer contacted thought the horse ranks among the great-est thoroughbreds.

“He’s one of our all time greats. The horse had an unbelievable presence. The little time I had around him, being in the shed row with him, he was just unbeliev-able. It's hard to describe what a perfect horse he was,” said Dallas Stewart, a popular trainer based in the Northeast.

Junior Serna, trainer at Lamb-holm South, based in northwest Marion County, and a past race track trainer, would have liked to see the horse run another year.

“We’d have to put him up there with the top horses. I would have like to see him run as a 4-year-old. I know he beat older horses in the Breeders' Cup Classic. He would probably beat them the same because he’s got so much natural

speed and he keeps going. It wouldhave been nice for the industryto have him for one more year,”Serna said.

Reade Baker, a Canadian-basedtrainer, said American Pharoahhad nothing to gain by racinganother year.

“Once he drew away in theBreeders' Cup Classic there wasnothing more to prove. He beatolder horses by as far as you canthrow a rock. He did everything.He’d just beat up on the samehorses he beat up in the Breeders'Cup Classic,” Baker said.

None of the trainers were will-ing to proclaim American Pharoahas the greatest.

“It’s kind of like asking who'sthe best quarterback ever. It’s sohard. He won the Triple Crownand did it really impressively. He’sdone stuff that no other horse hasdone. I think he ranks right upthere pretty high, but it’s hard tosay who's the greatest,” said ChadStewart, who is based in MarionCounty and trains at Tampa BayDowns.

Baker came the closest whenasked if American Pharoah wasthe best thoroughbred that everran a race.

“I thought the best horse I'veever seen was Dr. Fager. The bestyoung horse I’ve ever seen wasSpectacular Bid and I thoughtAmerican Pharoah was every bitequal to that horse,” he said.

Melvin James broke and trainedAffirmed, who won the TripleCrown in 1978. James still breedshorses in Reddick. He brokeAffirmed in Marion County.

“I have to be in favor ofAffirmed. And in those days theyweren’t shielded the way they aretoday. And Affirmed was muchmore resilient than AmericanPharoah," James said.

Affirmed won seven of his nineraces as a 4-year-old.

Much of the attention AmericanPharoah is getting is because theracing industry needed a boost andbecause there hadn’t been a TripleCrown winner in 37 years.

“I think he’s a great second tierhorse,” James said. “He never hada horse that really looked him inthe eye.”

Jim Dunleavy, senior editorat the Daily Racing Form, saidAmerican Pharoah should not beshorted for the things he did notdo.

“He’s done everything that wasasked of him,” he said.

Dunleavy said he did not wantto compare American Pharoah tohorses that raced 60 and 70 yearsago.

“He’s absolutely a first-ratehorse. Best of all time? I don’tknow,” Dunleavy said. “Youcan only succeed in the situationyou’re in.”

—Correspondent Carlos E. Medina contributed to this story. —Reach Fred Hiers at [email protected] and 352-867-4157.

PHAROAHFrom Page A1

Triple Crown winner Affirmed appears to be smiling along with jockey Laffit Pincay after winning the $312,800 Santa Anita Handicap in 1979 in Arcadia, Calif., by four lengths, setting a track record time of 1:58 and 3⁄5 for the 1 ¼ mile. Pincay, who replaced Steve Cauthen as Affirmed’s jockey prior to the winning effort in the Strub Stakes, sent the 1978 Horse Of the Year out fast then paced him behind Painted Wagon then took the lead in the far turn. AP PHOTO/NICK UT

Man O’ War is shown in a 1929 file photo. AP PHOTO/FILE

“We’d have to put him up there with the top horses. I would have like to see him run as a 4-year-old. I know he beat older horses in the Breeders’ Cup Classic. He would probably beat them the same because he’s got so much natural speed and he keeps going. It would have been nice for the industry to have him for one more year.” —Junior Serna, trainer at Lambsholm South