The NY Times Reports a Fraction of Medicare Doctors Get Big Share of Payouts

Today CMS has reported that a small fraction of the 880,000 doctors and other health care providers who accept Medicare,  accounted for nearly a quarter of the roughly $77 billion paid under the federal program, according to the most detailed data ever released in Medicare’s nearly 50-year history.

Fraud investigators, health insurers, researchers and others will spend weeks poring over the new source of information about how many tests were ordered and procedures performed for every provider who received Medicare payments under Part B.

The Medicare data, all for 2012, provides an unprecedented look at the distribution of Medicare payments.  The data also provides patients with an ability to compare doctors and treatments in a way they have not had until now.  For decades, the American Medical Association, and others, have blocked the release of the information, citing privacy concerns and the potential for misuse of the information. But a Federal judge ruled last year that the information could be made public.  You can access any doctor’s data by clicking here.

In 2012, 100 doctors received a total of $610 million, ranging from a Florida ophthalmologist who was paid $21 million by Medicare to dozens of doctors, who received more than $4 million each that year. More money by far is spent for routine office visits than any other single expenditure.  Medicare paid $12 billion for 214 million office and outpatient visits, most of them described as between 15 and 25 minutes long. The practitioners were paid an average of $57 a visit.

Total Medicare spending, including hospitals, doctors and drugs, is approaching $600 billion a year, but payments to individual doctors have long been confidential. The data shows much of Medicare spending is concentrated among a small fraction of doctors. About 2 percent of doctors account for about $15 billion in Medicare payments, roughly a quarter of the total, according to an analysis of the data by The New York Times.  These figures exclude commercial entities like clinical laboratories and ambulance services, which account for $13.5 billion of the $77 billion total.

Break Away from the Static

The release of the information is likely to increase attention to particularly controversial areas of spending. Experts say the data must be used with caution. An individual doctor, for example, may seem to have a high volume of services because that doctor oversees medical residents or physician assistants but bills for those services.  But regulators and others are also likely to seize on some of this information to find those doctors who perform an unusually high volume of services, raising the question of whether every test or procedure was medically necessary.

Among doctors who bill Medicare, the highest-paid 2 percent accounted for almost one-quarter of total Medicare payments.

SPECIALTY

NUMBER OF PROVIDERS

TOTAL MEDICARE

PAYMENTS

Ophthalmology

2,995

$3,318,657,539

Hematology/Oncology

1,831

2,087,433,062

Cardiology

2,176

1,600,357,118

Radiation Oncology

968

1,082,775,815

Internal Medicine

1,317

957,509,053

Dermatology

1,142

947,065,872

Rheumatology

708

708,647,535

Medical Oncology

522

621,687,169

Diagnostic Radiology

726

591,702,188

Nephrology

574

445,977,670

Pathology

274

296,480,315

Family Practice

302

225,264,485

Orthopedic Surgery

309

205,393,387

Urology

288

192,929,167

Pulmonary Disease

299

190,249,661

Vascular Surgery

172

173,089,583

Neurology

233

166,658,912

Physical Medicine and Rehabilitation

190

138,001,241

Interventional Pain Management

153

116,961,092

Hematology

71

83,484,326

General Surgery

88

77,399,978

Infectious Disease

111

76,372,853

Gastroenterology

106

67,715,863

Interventional Radiology

38

64,034,447

Anesthesiology

88

63,062,128

Podiatry

91

58,037,727

Pain Management

62

49,081,224

General Practice

58

43,992,599

Physical Therapist

48

36,143,850

Endocrinology

54

34,662,473

As always, ADVOCATE will keep you updated on this and all issues impacting radiology as they become available.

Best regards,
Kirk Reinitz, CPA
President/CEO