Doctors: Newly Released Payment Data Could Be Misleading

On Wednesday, physicians and physician groups reacted to CMS' release of Medicare payment data, warning that the information could lead to inaccurate conclusions about the providers' incomes and quality of care, the Washington Post reports (Millman/Fallis, Washington Post, 4/9).

CMS on Wednesday publicly released the data for the first time since 1979, showing how the program paid out $77 billion to more than 880,000 health care providers in 2012. The data included information on payments made under Medicare Part B to all participating providers (California Healthline, 4/9).

While some physicians said the step toward transparency was needed, they also criticized CMS for releasing the information without any additional context.

For example, some physicians noted that the payments do not equate to profits but instead cover treatment costs and staff wages.

Gerald Ho, a Los Angeles-based rheumatologist who received close to $5.4 million in Medicare reimbursements in 2012, said, "People are going to see these numbers and people aren't going to understand." He continued, "I am not pocketing $5.3 million." Ho said about $5 million covered genetically engineered treatments given to his patients, as well as paying a staff of 40. He added, "To tell you the truth, I know there’s been a lot of Medicare fraud, and I understand the government wants to provide a measure of transparency. But when they throw out numbers like this without any context, it’s going to be misconstrued by the public" (Washington Post, 4/9).

Meanwhile, some physicians noted that they are listed as the billing physician for Medicare services for an entire practice, even though they did not order the services themselves (Grady/Fink, New York Times, 4/9). For example, Mayo Clinic Laboratories Director Franklin Cockerill received $11,068,463 in Medicare reimbursements in 2012, according to the data. However, Cockerill is named as the billing physician for more than 23 million tests performed annually by Mayo Clinic physicians, a Mayo spokesperson explained. Mayo Medical Laboratories Marketing Administrator Andy Tofilon added that Cockerill receives a salary and, therefore, "has no financial stake in being included in all of these reports" (Washington Post, 4/9).

Meanwhile, physician organizations criticized CMS for releasing the data before physicians could review it for accuracy.

Concern About Misinterpretation

The American Medical Association -- which opposed the release -- noted that patients could misuse or misinterpret the data.

AMA President Ardis Dee Hoven said, "When a patient simply looks at raw data and does not have in front of them all of the various things that are applied in context to interpreting the data, are they in fact more prepared to make the right decision?" adding, "My answer to that to that is probably not" (Pittman, MedPage Today, 4/9).

Physicians also expressed concern that the data could affect how quickly patients pay their out-of-pocket costs to providers. Neal Haynes, a Texas-based neurosurgeon who received nearly $170,000 in reimbursements in 2012, said the data could lead patients to believe their providers are financially secure and therefore delay payments (Gever, MedPage Today, 4/9).

CMS cautioned against people making assumptions based on the data. CMS Principal Deputy Administrator Jonathan Blum said, "People should not jump to a conclusion because they see a spike in spending. The goal is to have a more informed conversation not just within Medicare but the broader health care community" (Terhune/Smith, Los Angeles Times, 4/9).

Focus on Ophthalmologists

According to the CMS data, ophthalmologists received the largest Medicare reimbursements in 2012. Nearly $5.6 billion -- or 7% of the total Medicare payments -- went to 17,000 ophthalmologists.

According to the New York Times, the figures reflect an aging U.S. population and the relatively small number of providers who have the ability to perform difficult and often expensive procedures, such as cataract surgeries.

However, ophthalmologists called the data misleading, noting that the majority of the reimbursements offset treatment that often can be costly. In addition, many noted that they often treat patients who are typically older than other specialties' patients (Pollack/Abelson, New York Times, 4/9).

Ties Between Top Reimbursed Docs, Political Parties

Meanwhile, the New York Times reports that two Florida-based physicians listed among the country's highest-reimbursed physicians are also major donors to the Democratic Party and have sought political help to shield them from Medicare fraud accusations.

The Times highlights the cases of physicians Salomon Melgen and Asad Qamar, both of whom have been the target of recent Medicare fraud investigations. According to the Times, both physicians turned to political contacts to potentially help clear their names in the investigations (Robles/Lipton, New York Times, 4/9).

Top 10 Reimbursed Docs Shed Light on Charges

High treatment costs are a large driver behind the nation's uppermost Medicare reimbursements, according to interviews conducted by the Washington Post's "Wonkblog." According to "Wonkblog," a little more than 50% of the $61.9 million paid to the top 10 reimbursed physicians covered drugs and "other costs."

According to "Wonkblog," the Medicare payment system incentivizes physicians to prescribe more costly treatments because they are reimbursed for the average price of a drug, plus 6%.

"Wonkblog" also reports that three of the top 10 reimbursed physicians have been the targets of fraud investigations, with one facing federal fraud charges.

The "Wonkblog" post includes interviews with some of the top 10 reimbursed physicians (Millman, "Wonkblog," Washington Post, 4/9).