Medicare Millionaires: CMS Releases its Annual Doctor Payment Data

The US Centers for Medicare and Medicaid Services (CMS) today released its first annual update on how the $90 billion spent in 2013 in fees to participating physicians was allocated. The database shows how much individual physicians were paid. That makes it possible to see who got paid the most.

Last year’s data release provided fodder for editorial outrage, with some physicians being pilloried in print for what appeared to be unjustifiably high payment totals.

This year, CMS made some changes, attempting to clarify its data reporting process.

Early this morning, Bloomberg news released its analysis of the numbers, noting that a few Medicare doctors like one who was paid $15.9 million are under legal scrutiny--but that the average payment was about $70,000.

The data are all about payments made under Medicare Part B fee-for-service (FFS).

Payments include those made to non-physician providers under a physician’s license, to ambulatory surgery centers, laboratories and ambulance services. It does not include payments to institutions or vendors of durable medical goods.

CMS excluded payments in cases where a provider cared for 10 or fewer Medicare patients.

That is a change from last year.

Another change is that drug payment data are presented separately.There were several individual physicians whose payment totals looked outrageously high because drugs they were providing, such as certain eye medications or cancer drugs, were very expensive.

Commenting on the data released this year, the American Medical Association said while it is “committed to transparency” it is not satisfied with CMS’s performance.

In a statement from its president Robert Wah, MD, the AMA said that on the positive side, separating the drug costs from payments for physician services is “a key improvement.”

“However we remain concerned that the 2013 data still has significant shortcomings,” Wah said.

Those include a lack of “actionable information on the quality of care” a physician gave.

“It also does not provide enough context to prevent the types of inaccuracies, misinterpretations and false assertions that occurred the last time the administration released Medicare Part B claims data.”

The data set includes lists of the average high Medicare-allowed amount per provider for medical services and a similar list of average high drug costs per provider.

For instance, radiation oncology topped the provider specialty list at $403,512 and hematology/oncology drugs topped the amount individual providers were paid for prescriptions at $583,237. Rheumatology was on the lists with providers getting an average of $156,839 and for services and the durgs prescribed per provider costs $298,011.

CMS also calculated the regional rates at which people covered by Medicare make medical office visits.

The average national was 6 visits a year though in New York, NJ, Florida, and Tennessee it was over 7 visits, and in 9 states it was below 4 visits.

In addition to Wah’s statement, the AMA offered a guide to interpreting the data.

According to the AMA, the CMS data may contain errors in both basic information about individual physicians (such as their specialty and address); lack of explanation when a physician provide extra services or tests out of medical necessity; lack of clarification that more than one provider can bill under a physician’s provider number; no allowance for the socio-economic demographics of the physician’s catchment area; no explanation that the data do not include facility fees, and other concerns