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October 20, 2014

New Medicare data show how Minnesota doctors compare

Minnesota ranks in about the middle among the states when it comes to Medicare doctor reimbursements, according to new data released this week by the the Center for Medicare Services.

In Minnesota in 2012, health care providers were reimbursed an average of 30 percent of the costs of Medicare-related bills.

This breaks down to an average of almost $33,000 per provider for the 819,803 Medicare beneficiaries in the state, according to an analysis of the federal data by USA Today.

That’s just over the country’s median payment — the point at which half the amounts are higher and half are lower — of $30,265, The AP reports.

Check out this map. 

USA TODAY

In all, the data show, Medicare paid 880,644 health care providers a total of $77.4 billion in 2012. The number of procedures, total pay and reimbursement rates varied by provider type.

More on Minnesota docs

The numbers are the most detailed data ever released in Medicare’s nearly 50-year history, The New York Times reports.

The unprecedented data reveal the wide range of reimbursements to doctors, clinics and other health care providers that provide Medicare services across the country.

Just a small fraction of the 880,644 health care providers who accept Medicare took home nearly a quarter of the roughly $77 billion paid out to them under the federal program, receiving millions of dollars each in some cases in a single year.

The New York Times reports in 2012, just 100 doctors received a total of $610 million, ranging from a Florida ophthalmologist who was paid $21 million by Medicare to dozens of doctors, eye and cancer specialists chief among them, who received more than $4 million each that year.

While more money by far is spent for routine office visits than any other single expenditure, one of the most heavily reimbursed procedures — costing a total of $1 billion for 143,000 patients — is for a single treatment for an eye disorder common in the elderly.

About 1 in 4 of the top-paid doctors — 87 of them — practice in Florida, a state known both for high Medicare spending and widespread fraud.

Rounding out the top five states were California with 38 doctors in the top group, New Jersey with 27, Texas with 23, and New York with 18, The AP reports.

One ophthalmologist alone, Salomon Melgen, took in more than $20 million from Medicare in 2012, USA Today reports.

Last year, Melgen’s offices were raided by the FBI and Department of Health and Human Services. Melgen has said he had done nothing wrong.

Federal officials say they released the data now to enhance transparency, Niall Brennan, acting director of the Center for Medicare Services Office of Enterprise Management.

Although Medicare is financed by taxpayers, the data have been off limits to the public for decades. Physician organizations went to court to block its release, arguing it would amount to an invasion of doctors’ privacy.

But employers, insurers, consumer groups and media organizations lobbied for the release of the data. They argued the data could help guide patients to doctors who provide quality, cost-effective care.

A federal judge last year lifted the main legal obstacle to release, and the Obama administration recently informed the American Medical Association it would open up the claims data.

The American Medical Association expressed concern that the release of raw payment data may lead patients to the wrong conclusions.

“The AMA is concerned that CMS’ broad approach to releasing physician payment data will mislead the public into making inappropriate and potentially harmful treatment decisions, and will result in unwarranted bias against physicians that can destroy careers,” Ardis Dee Hoven, president of the Chicago-based group, wrote in an e-mail to Business Week.

Some of the numbers may be inaccurate and doctors haven’t been given a chance to review the data and make corrections, Hoven says.

The data doesn’t show whether charges and payments under one doctor’s name apply to procedures done by other doctors in their employ, potentially increasing the amount of money they receive and the number of patients they care for.

But the data offer valuable insight into doctors’ billing practices across a variety of specialties.

USA Today reports the new access to the data also could help law enforcement track down fraud in the system.

And the data could be used by the consumers themselves, says Gail Wilensky, former Medicaid program director under President George H.W. Bush.

“This will be part and parcel of what we’re trying to do in this country of getting more consumer involvement,” she says. “An employer group can look at outcome data. They have big samples. And they can look at other physician groups with similar populations.”