Health care

Medicare reveals physician payment data

 

dchang@MiamiHerald.com

Federal health officials on Wednesday pulled back the curtain on payments made to physicians and other health care providers who treat Medicare patients, revealing for the first time once closely-held information such as the prices that individual doctors charge for their services and how much the government reimburses them.

The data shines a light on the federal health program for seniors and the disabled, which paid more than $77 billion to about 880,000 doctors and other health care providers in 2012, allowing researchers and consumers to see how often physicians performed certain procedures, how many Medicare patients they treated, and other information.

The Medicare data, which contains more than 9 million records, will eventually help patients — even those who do not receive Medicare — find the best value for their money and become more sophisticated healthcare consumers, said Jonathan Blum, deputy principal administrator for the Centers for Medicare and Medicaid Services, the federal agency that runs the health program.

Blum characterized the data dump as “a huge step towards making the Medicare program and the broader healthcare delivery system much more transparent.’’

He also expressed the hope that the data will help patients become more vigilant about the taxpayer-funded health program.

“We want the public’s help to identify spending that doesn’t make sense,’’ he said, “that appears to be wasteful, that appears to be fraudulent.’’

Yet Blum and other health policy experts urged caution against jumping to conclusions about outsized payments to physicians, or doctors who treat large numbers of patients or perform many procedures.

For instance, Blum said, ophthalmologists and oncologists figured prominently in the data — generating higher payments on average than other physicians — because they use expensive drugs as part of their practice.

“The reason ophthalmologists and oncologists are high relative to other specialties is due to the payment system for those drugs,’’ he said.

But he expressed a hope that patients would use the Medicare data to “sharpen the conversation” and ask questions of their physicians and their treatment methods.

Steven Ullmann, a health policy expert at the University of Miami, said consumers eventually will use such price data, combined with information about quality of care, to get the most value for their healthcare spending.

As more health plans pass on costs to consumers through higher deductibles, and higher co-payments and co-insurance rates, Ullmann said, patients will have to make more careful decisions.

“When you have information about the way services are provided and you have pricing information,’’ Ullmann said, “that’s when you can make appropriate choices.’’

Medicare’s release of the data also signals a slow but deliberate transformation in the business of healthcare, said Andrea Caballero, program director for Catalyst for Payment Reform, a California-based nonprofit that partners with large employers such as Walmart and AT&T to advocate for healthcare price transparency.

“It’s a building block to a new system,’’ Caballero said. “It helps us get a more complete picture of the marketplace. So once we see price, once we see quality, once that’s transparent, consumers are in a much stronger position to make informed decisions on what’s in their best interest. And they can’t do that without the information.’’

Wednesday’s release of Medicare physician payment data is part of the Obama administration’s efforts to encourage price transparency among hospitals, doctors and other health care providers as part of overall healthcare reform.

It follows last year’s release of hospital charges and payments received under Medicare for the most common inpatient and outpatient procedures, which revealed significant variations in hospital prices for similar procedures — even when those hospitals were located within close proximity.

Yet while the Medicare data released Wednesday is insightful, it also has limitations. For instance, it does not reflect a physician’s total patient base, which can include those covered by private insurance or other programs, such as Medicaid.

The data also only shows billings for 2012 under Medicare Part B, which covers payments to physicians and other health care providers for services delivered at hospitals, in offices or other facilities.

Medicare Part B also covers medical supplies and services such as laboratory tests, X-rays and physical therapy, as well as ambulance services and some home health care.

The data does not include beneficiaries in Medicare Advantage plans offered through private insurers, which accounts for more than 25 percent of eligible seniors. It also excluded doctors who treated 10 or fewer beneficiaries in order to protect patient privacy.

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