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Medicare Millions, Medicaid Millions, HealthcareThe Centers for Medicare & Medicaid Services released a listing on April 9, 2014, of healthcare and wellness data compiled from hundreds of thousands of providers and their 2012 Medicare payments/billings. This is the first time this kind of data has been available since a 1979 court injunction sealed it. The data set has information about healthcare provided to Medicare beneficiaries, as well as utilization, payments, submitted charges, medical codes and places of service.

Obama Administration Opens Records

Medicare payments data was sealed in the early 1980's when medical associations claimed physician privacy. But a lawsuit in 2013 prompted a federal judge to lift the injunction and the Obama administration made all payment information public this year. Now people can look up how many and what kinds of procedures a doctor bills to Medicare, which doctors get paid the most through the program, and how Medicare billings compare doctor to doctor.

The release of the Medicare healthcare and wellness data is part of the President’s efforts to reform healthcare with transparency and accountability and make it more affordable. Making the data available to public and research monitoring will better reveal waste in the multi-billion-dollar Medicare system that serves the elderly and disabled, and present an opportunity to understand how doctors practice within the Medicare program.

Medicare Millions

The data shows Medicare payments of more than one million dollars each in 2012 to thousands of doctors, and more than ten million dollars in payments to seven doctors. The largest healthcare and wellness payments went to three percent of doctors who received almost 28 percent of the billions paid out annually. The data also shows that eye doctors are among the most highly compensated of all.

The interpretation of the newly released data is being debated, with doctors sayingit incorrectly appears as large dollar payments but billing codes were shared. Consumer groups say the release of payment details helps to reveal fraud, and health care policy experts say it will help everyone understand how Medicare is actually utilized.

The Lion's Share

The average paid out to doctors by Medicare is $77,000, but the top three percent of doctors providing Medicare services received more than 10 times the average - about $788,000. Oncologists and ophthalmologists are in that three percent. Cardiologists and internists are also among the highest paid doctors in Medicare. Consumer groups are hoping to zero in on Medicare doctors who over-utilize in-office tests and procedures in order to cut waste and save money throughout the government system.

The American Medical Association is critical of the data release and interpretation, calling it a “broad data dump [with] significant shortcomings regarding the accuracy.” The organization is concerned that the public availability of the data leaves it open to scrutiny without context and invites misinterpretations, especially in regards to provider codes. Medical directors’ provider codes may be used by multiple doctors for billing in facilities they manage, giving the appearance of more usage by a doctor than is actually occurring. The AMA also explains that higher spending in some areas may not be due to fraud but instead to new medicines or procedures, such as in treatments for macular degeneration, a leading cause of blindness in older people.

While it’s clear that proper interpretation of the newly released data is necessary to best understand it and make improvements, more transparency and accountability are necessary to better control costs and eliminate waste and fraud. By opening the data to the public, advancing technology and social media may make it possible for Medicare to better use the data for improvements and cost savings.

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