Doctor Payments Revealed

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The administrators of Medicare, the federal health insurance program for the elderly and disabled, have long sought to make public how much individual doctors are paid through the program. Until last year, however, they were stymied by lawsuits filed by doctors’ organizations, many of which opposed the release of this information on privacy grounds. But when a federal judge overturned a longstanding injunction against releasing this data last May, workers at Medicare began to create a list of all procedures for which over 880,000 doctors were reimbursed as part of the program in 2012. The resulting data set, in which all patients are anonymous, was released to the public last week.

Much of the media coverage surrounding this massive trove of data has focused on the doctors who received the largest payments from Medicare. As noted in a Medscape article published last week, just short of 4,000 doctors — less than 0.5% of all Medicare doctors — received more than $1 million from Medicare in 2012. The average amount Medicare paid doctors that year was about $77,000. Some doctors in this group were paid significantly more than $1 million: 344 doctors were paid $3 million or more, including one Florida ophthalmologist who received $21 million. Of the 344 doctors in the $3 million-and-above group, 151 were ophthalmologists, and collectively they received $658 million in Medicare payments. Oncologists also represented a large share of the highest-paid doctors.

According to Jonathan Blum, principal deputy administrator of the Centers for Medicare and Medicaid Services (the federal agency that runs Medicare), as quoted in the Medscape article, both ophthalmologists and oncologists use expensive drug therapies as part of their practices; this helps explain why they tend to receive much larger payments from Medicare. In addition, the program’s reimbursement rate for a given procedure takes all costs into account, including not just direct drug costs but also overhead such as staff and equipment used in the procedure. As noted in a New York Times article last week on the “pitfalls” of the Medicare data set, the data reveal only how much doctors got paid, not what they got paid after expenses. In some cases, nurse practitioners, physician assistants, and even other doctors shared payments made to a single doctor through Medicare.

The single biggest item for which Medicare paid doctors, however, was a simple office or outpatient visit. Out of about $64 billion in total payments to individual doctors, $12 billion paid for office visits, mostly between 15 and 25 minutes in length. About 214 million visits were reimbursed, which means the average payment was about $57 per visit.

But one pattern in the Medicare data set seems difficult to explain: the enormous disparity between different states in spending per Medicare enrollee. Each procedure covered by Medicare carries the same payment rate in each state, so higher spending must be the result of more procedures or more expensive procedures being billed for each Medicare patient in certain states. As noted in an article from the Brookings Institution, average spending per enrollee ranged from $144 in Puerto Rico (Idaho was lowest among the 50 states at $619) to $2,073 in Washington, DC (New Jersey was highest among the 50 states at $2,041). As shown in this graph from the article, other high-spending states were Texas, Florida, and New York, while low-spending states included New Mexico, Minnesota, and Oregon.

What’s your take on Medicare releasing this data — do you support making doctor payments public? If not, why not? Should Medicare have done more to put payment amounts into context? Will you be looking up your own doctor(s), as one can using this page? Should patients care how much Medicare is paying their doctors? Leave a comment below!

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