Filed Under:Health Insurance, Individual Health

Data release puts big Medicare billers in spotlight

CMS Director Jonathan Blum (AP photo/HHS)
CMS Director Jonathan Blum (AP photo/HHS)

(Bloomberg) -- Medicare paid about 4,000 medical professionals more than $1 million apiece in 2012, according to Centers for Medicare & Medicaid Services (CMS).

The Medicare program paid seven providers more than $10 million in 2012, the program paid one Florida ophthalmologist $21 million.

CMS included those figures in a database released this morning.

The database shows exactly what Medicare paid in 2012 to about 880,000 doctors and other care providers. The database lists the providers by name and covers $77 billion in payments.

The New York Times has posted an easily searchable version of the database here.

Medicare paid an average of just $77,000 per provider.

The average was highest for cancer doctors specializing in blood work and radiation. They averaged about $360,000 in annual Medicare revenue.

The Obama administration decided last week to make all payment information public, excluding for privacy purposes cases in which doctors performed procedures on fewer than 11 patients.

Consumers can now see aggregate sums paid to a doctor, how that amount compares to their peers and which doctors made the most from the program. They can also see the type and how many procedures a doctor billed Medicare for.

Also included were payments to laboratories, group practices, ambulance services, and mobile X-ray providers. Multiple entities with Quest Diagnostics in their names collected a total of $669 million from Medicare, and listings for Laboratory Corporation of America Holdings totaled $717 million. The figures generally are totaled by location, not by parent company, so it’s not possible to be certain that all those with a common name are owned by the same company.

California and Florida received the largest payments with each getting more than $7 billion from Medicare followed by Texas and New York, with $5 billion a piece.

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While drug and hospital costs have been scrutinized, less attention has been paid to doctors’ fees, which accounted for about 12 percent of Medicare’s budget in 2012. Making the data available may allow the public and researchers to better identify fraud and waste by doctors in the $604 billion Medicare system.

The data release has been lauded by consumer groups seeking to spotlight possible fraud or overuse and criticized by physicians, including the American Medical Association, whose head has said misinterpretation could ruin doctors’ careers.

Medicare payments to doctors were kept from the public after medical associations argued in the early 1980s that their release would violate physicians’ privacy. Last May, a federal judge lifted a 33-year-old injunction on the data following a lawsuit by Dow Jones & Co.

The data release could put more heat on doctors who engage in self-referral -- ordering up tests and procedures that are performed in their own clinics or in those in which they have a financial interest.

“This is an enormous event and momentous day and a long time in coming,” said Bob Kocher, a former special assistant to President Barack Obama for health care policy, in an interview. “What it’s going to help us do for the first time is figure out what these doctors actually do and what kinds of patients they actually see.”

“It will benefit not just consumers and the taxpayers but ultimately the health-care sector because it will shine some light in some dark corners where, frankly, health-care providers should improve the way they practice,” said Joe Antos a scholar at the American Enterprise Institute.

The AMA, which fought to keep the information private, said the data lacked context. Some doctors may be making more than the average from Medicare because they see a disproportionately high number of elderly, not because they are improperly billing the agency, according to Ardis Dee Hoven, president of the AMA. In other instances, a doctor may be doing more of a certain procedure because they have specific expertise in that area or better outcomes, she said.

“We are bracing for some significant unintended consequences,” Hoven said. “Patients may not get the right data and the outliers are going to have to stop what they are doing and be replying to folks day after day when nothing is out of kilter and they are just doing their jobs.”

The data do not include information on what percentage of a doctor’s practice is Medicare versus private insurance patients. Some of the numbers may be inaccurate and doctors haven’t been given a chance to review it and make corrections, Hoven said.

“We fear this information can be easily misinterpreted without a complete understanding of patient complexity and the cumbersome Medicare billing system,” said American College of Cardiology president Patrick O’Gara in a statement.

Medicare officials would not discuss specific doctors, Aaron Albright, a spokesman for the U.S. Centers for Medicare and Medicaid Services, said by phone. He didn’t immediately answer other questions about the data and Medicare’s use of it.

CMS is hoping that by releasing the data it can help cut waste from the Medicare system and improve cost-effectiveness, Jonathan Blum, deputy administrator for the Medicare agency, said last week in a blog post on the decision.

“Data like these can shine a light on how care is delivered in the Medicare program,” Blum said. ’’Businesses and consumers alike can use these data to drive decision-making and reward quality, cost-effective care.’’

The move has been welcomed by health research firms and consumer groups who’ve been looking for insight into how Medicare spends its money.

--With assistance from Anna Edney in Washington, Graham Giller in Princeton and Phil Kuntz and Caroline Chen in New York.

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