Category: Provider Payments

Medicare Payments to Physicians and Other Providers: Analysis by Type of Provider.

Surprises, Disappointments, Confirmations, and Puzzles.

Most would agree, that transparency and accountability are in general, desirable. It does not necessarily follow however, that disclosure of previously hidden, obscure, or obtuse information arrives free of embarrassment for some or confusion for others. So it is with the recent unprecedented release by the Centers for Medicare and Medicaid Services (CMS) of the volume and cost of many of the services provided to some Medicare beneficiaries. Bothe the professional and lay media is fully energized with attempts to explain, excuse, or otherwise draw meaning from this voluminous and difficult-to-embrace set of data. Frankly, I have been rewarded with both surprise and disappointment, and with the satisfaction of solving puzzles. Clearly there is information here that both the professional and lay public must address if we are to benefit from a fair, effective, and efficient system of healthcare.

Ranking of Provider Types and Payments.
As a first step, I have broken down the 9+ million-item database by type of provider. There are 89 different types identified. (View the list here.) I attach 4 different PDF documents summarizing the same data in different views sorted by provider type, the number of individual providers in each provider type, the aggregate Medicare payments to each type, and the average payment for each provider of a given type. Please remember that there are many caveats attached to this data that must necessarily limit the conclusions that might be drawn. These are discussed by me in earlier articles of this series, and by others. Be that as it may, the view from 40,000 feet is instructive and shows us where to target more detailed analysis. Continue reading “Medicare Payments to Physicians and Other Providers: Analysis by Type of Provider.”

Analysis of CMS Release of Medicare Provider Payments Begins!

Both aggregate and detailed data for Kentucky and Louisville available for download below.

Its out there!
The release last week by the Centers for Medicare and Medicaid Services (CMS) of services by and payments to physicians and other non-hospital providers reverberated as expected throughout the nation. Analysis of the massive database is, and will continue to expose the complexity, quirks, inequities, fraud, and sometimes just plain bizarreness in our current health care system. Some large media outlets such as the New York Times, the Wall Street Journal, and the Washington Post were allowed to organize and work with the data before it was released to the general public. Both these sites and perhaps others allow the public to look up individual providers, but comparisons of individuals or groups is cumbersome to impossible. Furthermore, neither of these two portals to the data includes all non-physician providers. In any case, a host of individual providers or professional groups are now scrambling to try to explain why they stick out like sore thumbs in terms of frequency of services, charges, or payments from Medicare.

Eye doctors (and others) under the magnifying glass.
For example, ophthalmologists point out that the reason they receive among the highest payments is that they frequently inject an extremely expensive drug into the eyeball. While this may be rational and honest defense, it is not a reasonable one if, as is reported, it is true that a spectacularly cheap alternative generic drug works just as well. Thus, the issue of how much money a physician or other provider is entitled to make off a drug they chose to administer themselves is certain to enter public debate. Continue reading “Analysis of CMS Release of Medicare Provider Payments Begins!”

Medicare Payments to Physicians Now Available On-Line.

Take a look at the results for Louisville and Kentucky.

Our colleague Terry Boyd at Insider Louisville was probably the first out of the block this morning to report on the local results of the much-debated, long-opposed, and likely system-changing publication by the Centers for Medicare and Medicaid Services of the amounts of money charged by and payed to individual physicians and other providers for some Medicare patients. This previously top-secret financial and utilization information had not even been available to other physicians let alone the public.

Long opposed by organized medicine as a violation of individual physician privacy, the public has gotten used to, indeed gained an appetite for such information about hospitals, nursing homes and the like. This is part of the movement to increase medical safety, quality, and efficiency. It also has been very helpful for identifying medical fraud and abuse. I predict that the release of physician payment data will have as much earth-shaking effect as last year’s release of hospital payment data illustrated by the now-famous article in Time Magazine, “Bitter Pill: Why Medical Bills Are Killing Us,” by Steven Brill.

There will be much to learn from this extensive database. It is huge! My tricked-out Mac chokes on the size of it. You can look up individual physicians for a more detailed breakdown on the Washington Post Portal referred to by Terry Boyd, or the Wall Street Journal..  To give the community something to look at while I do the same, a more manageable aggregate list of all the physician and other non-hospital Medicare providers doing business in Louisville or the state of Kentucky is available below.  I have ranked the lists by the amount of money actually paid to individual providers– highest paid providers are at the top. Definitions of the individual items and some other comments about the data are present in the designated tabs. Continue reading “Medicare Payments to Physicians Now Available On-Line.”