On April 9, 2014, the annual payments individual physicians receive from Medicare were made public by the Centers for Medicare & Medicaid Services. This data had been confidential since 1979, after the American Medical Association successfully sued the government to keep the payment amounts secret. The Wall Street Journal filed suit in 2011, seeking public release of the data, and after additional Freedom of Information Act requests, CMS announced it would be made public.
Explore This IssueACEP Now: Vol 33 – No 06 – June 2014
The data, released on the CMS website, detail the amount individual providers were reimbursed for Medicare Part B services in 2012 and are broken down by CPT code, procedure type, number of units, and average charge. But interpretation of the data is not straightforward, particularly for emergency physicians who provide an assortment of services to a variety of patients.
“Although transparency is important, this data has so many confounders, it’s hard to reach clear conclusions,” said Michael Granovsky, MD, FACEP, president of LogixHealth, a national ED billing company.
Challenges to Analysis
While the data certainly highlight outliers who may be worthy of investigation—for example, a Florida-based ophthalmologist received $21 million from Medicare in 2012, according to the data, and he previously has been under investigation for Medicare fraud—additional details about the payments can provide important insights.
For instance, one of the highest-paid emergency physicians is credentialed in emergency medicine, yet most of his Medicare reimbursement was related to services performed at a vein clinic, the majority of which were endovenous laser procedures reimbursed at $1,133 each. Medicare paid him more than $1 million in 2012.
“The vein center services are not taking place in an ED and do not really have a direct relevance to ED care or costs,” said Dr. Granovsky. However, it’s there, embedded in the data along with everything else.
The CMS database includes more than 880,000 physicians with Medicare payments that rise as high as $20 million. Of these, 37,000 are emergency physicians with Medicare reimbursements of a few hundred dollars to nearly $2 million. Most range between a few tens of thousands to hundreds of thousands of dollars.
The wide discrepancy demonstrates that data alone do not tell the story.
“Typical ED groups receive annual Medicare reimbursement in the range of $50,000 to $80,000 per physician” said Dr. Granovsky, who analyzed a subset of representative data.
Part of what throws the CMS data off are outliers like the doctor in the vein clinic, or the vascular surgeon who ranks as the highest-paid “ED” physician in the CMS dataset. Medicare paid him more than $1.8 million in 2012. He is board certified in general surgery and vascular surgery, and the bulk of his payments came from the $733,641 of complex femoral-popliteal artery revascularizations he performed. Few ED services contributed to his Medicare payments.