Medicare Releases Data on Individual Physician Payments

Doctor with MoneyAs part of the Administration’s efforts to promote better care, smarter spending, and healthier people, CMS has posted the third annual release of the Medicare hospital utilization and payment data (both inpatient and outpatient) and the second annual release of the physician and other supplier utilization and payment data. The data is online in a searchable database and accessible by the public.

The Medicare agency said that for privacy reasons it redacted payment records for procedures by physicians per-formed on fewer than 11 patients that year.  And the records cover only payments received directly from Medicare, not privately run Medicare Advantage plans, which cover about 30% of Medicare patients.

In April 2014, the Medicare agency released the first batch of payment records—covering 2012—that showed the amount received by each provider for services rendered to Medicare patients. With the release of 2013 data, the public and news organizations can for the first time compare how the billings of individual doctors and medical providers evolved over time.

According to an article in the Wall Street Journal, the top 1% of physicians in terms of Medicare billings reaped 17.5% of all payments to individual providers in 2013. That is up from 2012 when the that same cluster of doctors and other individual providers received 16.6% of the program's payments.  The data reveal how Medicare’s one-percenters reach the top echelon of payment recipients—and how they stay there. The top billers ranged from doctors who specialize in treating the sickest, most complicated patients to those who expand their practices beyond treatment to bill costly laboratory tests or other add-on services.

The nation's biggest 2013 biller, Anne Greist, received $28 million, almost all of it for costly treatments for a small number of patients with the rare blood disorder hemophilia. The patients receive courses of treatment that can cost more than $1 million a year.  The top billers were heavily weighted toward Hematology/Oncology and Ophthalmology - reflecting the high cost of drugs like the melanoma treatment Yervoy and the prostate-cancer treatment Provenge.

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