Upon the release of the CMS database, The Wall Street Journal and The New York Times quickly developed online tools to help people access the data and to provide perspective. The 9 million records included in the dataset can also be downloaded in text-delimited format from the CMS website as a .zip file that is 1.7 GB when uncompressed. It must be imported into a database or into statistical software; otherwise, the data is unwieldy, said Dr. Granovsky.

A disclaimer on the CMS website highlights that the data may not represent the full scope of a physician’s practice nor is it indicative of the quality of care provided or the health of a physician’s patient population. The data also do not provide a barometer for the necessity of the tests and procedures performed or whether they were effective.

Still, it can be difficult to reconcile the fact that seven doctors received more than $10 million from Medicare in 2012 and 4,000 physicians were paid at least $1 million. In addition, a quarter of doctors in the dataset were responsible for capturing more than a third of the $77.4 billion in payments, and one in three of the top earners were ophthalmologists.

Radiation oncologists were also top earners on Medicare’s payroll. Fewer than 1,000 doctors within the specialty accounted for a total of $1.1 billion in payments.

A quarter of doctors captured more than a third of the $77.4 billion in payments, and one in three of the top earners were ophthalmologists.

Applications to Emergency Medicine

Dr. Granovsky recommends all emergency physicians compare the CMS data to their own billing records; those who find themselves to be significant outliers should take a deeper dive into the data. According to The Wall Street Journal, regulators are scrutinizing high-paying codes, especially in places like the ED. Hospitals and health systems are also using the information to better understand how to limit and control high costs.

Payments to emergency physicians are confounded by multiple factors. Those who own urgent care centers might receive Medicare payments for hundreds of thousands of dollars, but most of it relates to medication costs and ancillary services in the urgent care center, not the traditional ED evaluation and management services most emergency physicians report.

Additionally, the CMS data do not capture some of the critical clinical factors that determine how much aggregate Medicare reimbursement emergency physicians will receive, like the volume of Medicare patients in the ED, the types of shifts the physicians work, and whether they are scheduled in the main department or fast track. It also doesn’t identify certain hospital charges that may impact billing.