CMS Data Reveals Millions Paid to Some Physicians

In a move that some physicians have been dreading, the Centers for Medicare and Medicaid Services (CMS) released data on Wednesday revealing Medicare Part B payments to individual physicians and physician practices.

The database shows $77 billion of transactions by 880,000 physicians and practices in 2012. Some of the top billers received 100 times the average for their fields, according to Bloomberg. Just 25 doctors received a total of $231.7 million from the program.

"Data transparency is a key aspect of transformation of the health care delivery system,” CMS Administrator Marilyn Tavenner, said in a statement. “While there’s more work ahead, this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program.”

The publication of payments was done in the name of transparency, but many in healthcare are unhappy about the move as they fell the data can be misleading. While the American Medical Association (AMA) promotes transparency and providing information to patients so they can make informed decisions, the organization is one that has been wary of releasing the Medicare payment data.

"We believe that the broad data dump today by CMS has significant short-comings regarding the accuracy and value of the medical services rendered by physicians,” Ardis Dee Hoven, MD, president of the AMA, said in a statement. “Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences.”

The AMA released a separate statement pointing out the various ways people can misinterpret the data or how the data can be misleading. For instance, since residents and other healthcare professionals under a physician’s supervision can file claims under the physician’s National Provider Identified, the reported number of services could be misleading.

"Thoughtful observers concluded long ago that payments or costs were not the only metric to evaluate medical care,” Hoven said. “Quality, value and outcomes are critical yardsticks for patients. The information released by CMS will not allow patients or payers to draw meaningful conclusions about the value or quality of care. The AMA is disappointed that CMS did not include reasonable safeguards that would help the public understand the limitations of this data."

In the Washington Post, one rheumatologist explained that while he was paid $5.4 million in reimbursements, $5 million covered the cost of drugs and he still had to pay his staff of 40 at the 3 offices he runs.

The fourth highest paid doctor on the list, Franklin Cockerill of the Mayo Clinic in Rochester, MN, received more than $11 million in reimbursements. However, a spokesman explained to the Post that Cockerill, as the chair, is listed as the billing physician on more than 23 million tests a year.

Healthcare professionals, in general, had a strong negative reaction to the released data. According to MedPage Today, some were angry, claiming it was no one’s business what a physician was paid for his or her services. Meanwhile others worried the general public would “confuse payments with net earnings.”

"On paper, it looks like I have received many federal dollars, when in reality, I was working for an hourly wage and the institution got the money," one nurse practitioner commented on the MedPage Today survey.