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The release on Wednesday of Medicare
payment data is getting mixed reviews from doctors. Many say they favor
sharing information but worry that the data presented by Medicare omits
important details and may mislead the public and paint an unfairly
negative picture of individual doctors.
Dr.
Gary Heit, a recently retired neurosurgeon in Redwood City, Calif.,
said he thought some of the details revealed could be useful to patients
who want to make sure that the physicians they choose are experienced —
say in carotid-artery surgery, where more operations performed
correlate with better patient outcomes.
“Being
able to track the number of procedures is incredibly valuable,” Dr.
Heit said. “I think the ability to see the number of cases a physician
does is really important.”
However, the data only include treatments given to certain Medicare patients.
Many
other doctors worried that the data released was incomplete and often
misleading. In some cases, enormous payments that seem to be going to
one doctor are actually distributed to multiple others. But the data
tables do not reveal that the money was shared.
The highest-paid 2 percent of doctors received almost one-fourth of Medicare payments.
Share of Medicare payments to doctors
BILLIONS
TOP 2%
23.6%
$15.1
REST OF
TOP 25%
52.1
33.3
BOTTOM
75%
24.3
15.5
TOTAL
100
63.9
For
instance, Dr. Jean M. Malouin, a family medicine physician at the
University of Michigan Health Systems, shows up as one of the top
Medicare billers in the country, collecting payments of $7.58 million in
2012 for more than 207,000 patients. But Dr. Malouin directs a Medicare
project that involves 1,600 primary care physicians, who each receive a
small payment each month. Those payments are funneled through Dr.
Malouin. The doctor’s situation is described in a website that the hospital set up on Wednesday to help explain the data to the public.
Dr.
David L. Longworth, chairman of the medicine institute at the Cleveland
Clinic, said the data could also be misconstrued because it does not
explain that some doctors treat unusually ill patients who need a great
deal of complex, time-consuming care, for example those with heart failure
or advanced cancers. People who focus only on the payments may assume
that doctors who receive more money are doing something wrong, he said.
He
also noted that some doctors who work as salaried employees of group
practices like the Cleveland Clinic do not receive the amounts that show
up alongside their names in the data tables because the Medicare
payments go to their institutions.
Aaron
K. Albright, director of the Media Relations Group at the Centers for
Medicare and Medicaid Services, said the information was not misleading
but simply “represents payments made to the providers for the services
they provide.”
Dr.
Ardis Dee Hoven, president of the American Medical Association, said
her group was concerned about the data’s accuracy because of what she
described as a history of mistakes in Medicare’s database. She also
noted the lack of any information about the quality of services.
“We were told we would have an opportunity to see this data before it was publicly produced, and we were not,” Dr. Hoven said.
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more than 800,000 health care providers that received payments in 2012
from Medicare Part B.
Mr. Albright said he did not know of any promise made to the medical association about seeing the data before it went public.
Dr.
David A. Fleming, president-elect of the American College of
Physicians, said his group favored transparency, but added: “One concern
is that this is a huge data dump, and a lot of interpretation is
occurring without the data actually being analyzed, with exposure of
physicians who have been paid huge amounts of money. I understand the
implications, but there may be very legitimate reasons as to why.”
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Oncologists,
who receive some of the highest Medicare payments, are among those who
feel most unfairly treated by the data because the tables do not make it
clear that the payments must also cover their overhead — expensive chemotherapy drugs and the salaries of nurses and other professional staff.
Dr.
Robin T. Zon, an oncologist in South Bend, Ind., is listed in the
Medicare tables as having received more than $1.2 million in 2012, but
she said that 90 percent of it went to overhead.
Some
doctors feel a bit vulnerable and exposed by having details about their
income posted on the Internet for the whole world to see. “I have very
mixed feelings because I think there’s a lot of stuff about doctors
that’s already on public records, and it makes me anxious we’re being
examined to that extent,” said Dr. Ulrike D. Sujansky, an internist in
San Mateo, Calif.
“It’s
public record what prescriptions I prescribe. And that information is
also sold to the pharmaceutical companies,” Dr. Sujansky added. “Anybody
can look up if I have lawsuits. And now they’re going to find out what
my billings are. It does feel very invasive and intrusive.”
But
she also said: “I am pleased that light is being shed on the fact that
some physicians clearly do procedures for financial gain and not for the
benefit of the patients.”
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