Our opinion: That's a lot of money, but there's more to the story
Of the 825,000 individual physicians in Medicare's claims data base, 344 physicians took in at least $3 million apiece for a total of nearly $1.5 billion, according to a study by the Associate Press of data recently released by the Obama administration. (AP picked the $3 million threshold because that was the figure used by the Health and Human Services inspector general in an audit last year that recommended Medicare automatically scrutinize total billings above a set level.)
Topping Medicare's list was Florida ophthalmologist Salomon Melgen, whose relationship with Sen. Robert Menendez, D-N.J., made headlines last year after news broke that the lawmaker used the doctor's personal jet for trips to the Dominican Republic. Medicare paid Melgen $20.8 million.
Of those 344 physicians, 151 of them were, like Melgen, eye specialists, accounting for $658 million in Medicare payments. Cancer doctors rounded out the top four specialty groups, accounting for a combined total of more than $477 million in payments. Jordan Rau, writing for NPR, noted oncologists and ophthalmologists topped the list because their work involves expensive drugs, and in 2012, Medicare paid doctors for the market cost of drugs they used plus 6 percent.
About one in four of the 344 doctors practice in Florida. 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, according to the AP.
In total, Medicare paid individual physicians nearly $64 billion in 2012, with a median payment of $30,265.
This is the first time the data has been released in 35 years (in 1979, a court issued a gag order preventing anyone from revealing Medicare Part B payments to individual doctors), and it's no surprise that organizations such as the American Medical Association fought the release, contending it would amount to an invasion of doctors' privacy. But this is public money that comes from our taxpayers, so it's only right that we should know how it's dispensed.
In 2013, the United States spent $592 billion on Medicare, or 15 percent of our budget. By 2023, that cost is expected to increase to $1.1 trillion, in large part due to the aging of the baby boom generation. (Currently as a nation, we spend $2.8 trillion on health care.)
Employers, insurers, consumer groups and media organizations argued for release, claiming that the data could help guide patients to doctors who provide quality, cost-effective care.
"It will allow us to start putting the pieces together," Dianne Munevar, a top researcher at the health care data firm Avalare Health, told the AP. "That is the basis of what payment delivery reform is about."
The AMA warned that the documents AP relied on may contain inaccurate information.
"We believe that the broad data dump has significant shortcomings regarding the accuracy and value of the medical services rendered by physicians," AMA president Ardis Dee Hoven told the AP. "Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences."
It is hoped that the newly released data will help consumers become better educated about the doctors in their communities.
"For example," noted the AP, "if your father is about to undergo heart bypass, you could find out how many operations his surgeon has done in the last year. Research shows that for many procedures, patients are better off going to a surgeon who performs them frequently."
The data can also be used to spot fraud, such as doctors billing for seeing more patients in a day than their office could reasonably be expected to care for. It might also be used to help analyze how efficacious a doctor's treatment is.
But, according to the New York Times, the data is also being used to show the close connection between campaign giving and doctors who receive Medicare payments.
"Two of those doctors had given lavishly to Democratic politicians in hopes of getting Medicare investigators off their backs," stated the Times in a recent editorial.
One of those was Melgen, who in 2012, gave $700,000 to Majority PAC, a super PAC run by associates of Sen. Harry Reid, which in turn spent almost all of it to help re-elect Menendez, Melgen and his wife also gave $22,600 to Menendez's campaign, $10,000 to his PAC, $40,000 to the New Jersey Democratic State Committee, and $60,400 to the Democratic Senatorial Campaign, according to the Times.
"Did that have something to do with Mr. Menendez's intervention on the doctor's behalf with the head of Medicare? Based on the timing and the amount of money involved, it's hard to reach any other conclusion."
Menendez is being investigated by the Justice Department. Previously, he was forced to reimburse Melgen $70,000 for plane trips.
In addition, Dr. Asad Qamar, a Florida cardiologist, who received $18.2 million from the program in 2012, gave more than $100,000 to the Democratic National Committee and its state branches, along with contributions to the campaigns of President Obama and many congressional candidates, noted the Times.
"Then he hired a lobbyist to contact lawmakers to get federal investigators to back down. Does anyone doubt that there is a quid pro quo in these payments?"
As the New York Times noted, the Supreme Court's recent decision on campaign donations could make these questionable donations even more prevalent.
But Rau warned that we shouldn't leap to conclusions on the basis of the data alone, which is incomplete and doesn't account for procedures billed to one doctor but performed by a number of workers in his or her practice. For a more complete analysis of the data, noted Rau, you need information about how sick the patients were or why a particular procedure was performed.
"And large numbers of procedures performed by a doctor may be a good sign. Someone billing a lot might well be a very talented practitioner, since research has found that medical skill tends to improve the more times a physician performs the same operation."
But as the Los Angeles Times noted, "It is a powerful reminder that the program needs to stop rewarding doctors for the quantity of care they deliver rather than the quality."
"The concentration of payments -- a mere 2 percent of the doctors participating in the program took in almost a quarter of the fees -- exemplifies the problem with Medicare's ‘fee for service' payment system," wrote the Los Angeles Times. "This system ignores the value and effectiveness of the care provided, paying attention only to how many treatments are rendered. That gives doctors an incentive to provide the most expensive and intensive forms of care, not necessarily the treatments that work best."
While Congress is working on legislation that would encourage Medicare doctors to switch from fee-for-service to alternative payment plans that reward quality and efficiency, it has been hung up due to a dispute over how to pay for it.
We would also encourage readers of the data not to jump to spurious conclusions, but we believe the more information that is available, the better informed all of us can be. And there is no doubt, this is our money, we all have the right to know how it's spent, and how it can be better spent.
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