Medicare Payments Exposed

For the first time, the federal Centers for Medicare and Medicaid Services (CMS) has made public a database showing what it pays out to individual physicians.

In a press release, CME administrator Marilyn Tavenner stated that data transparency “is a key aspect of transformation of the health care delivery system. While there’s more work ahead, this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program.”

In 2012, Medicare paid $77 billion to 880,000 doctors, with nearly $1.7 billion of that going to 7,504 nephrologists (average $224,747) and $1.38 billion to 8,792 urologists (average $157,555).

Ninety-six nephrologists and 21 urologists received more than $1 million in payments each. Among the 96 nephrologists, total payments ranged from $1,003,835 to a nephrologist in Connecticut, to $2,987,182 to a nephrologist in California. Among the 21 urologists, payments ranged from $1,000,452 to a doctor in California to 2,141,927 to a clinician in Massachusetts.

The CMS has acknowledged that the database has some limitations. For example, the database only has information for Medicare beneficiaries with Part B fee-for-service coverage, “but physicians typically treat many other patients who do not have that form of coverage.” In addition, the database excluded any aggregated records derived from 10 or fewer Medicare beneficiaries to protect beneficiary privacy.

Transparency in the spending of taxpayer money generally is a good idea. It allows the press, and thereby the public, to look for wasteful spending, mismanagement, and fraud. This potentially could shape public opinion that, in theory, prompts lawmakers and policymakers to make changes to physician reimbursement.

The downside, in my view, is that divulging what Medicare pays to individual doctors by name can engender misconceptions among members of the press and public, who may see a huge dollar figure and wrongly suspect that a doctor is milking or bilking the system. Millions in Medicare dollars could flow to doctors for a number of legitimate reasons, such as high costs associated with the administration of certain treatments, especially medication costs.

In addition, now that Medicare payments to individual physicians are open to the public, some patients undoubtedly will look up their doctor’s Medicare income, if for no other reason than idle curiosity. They may be awestruck by the lottery-jackpot-size dollar figure they see, and gather that their doctor is rolling in dough without considering that much of this money goes to operating expenses and taxes and perhaps to paying down a huge debt burden.

Despite the risk of people jumping to conclusions, greater transparency serves the greater good in terms of the big picture of government accountability, and we all might be better off in the long term.

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