News Feature | April 11, 2014

Medicare Unveils Physician Payments Data

Christine Kern

By Christine Kern, contributing writer

Medicare Physician Payment Data

Medicare releases data on physician billing statements for 2012

Last week, CMS released the first-ever publication of Medicare Part B payments to individual physicians and physician practices. The data was released in response to transparency demands raised by the court case requiring the agency to provide public access to physician billing records.

According to the report, routine office visits accounted for the single largest share of Medicare physician billings in 2012, but amounted to just one one-seventh of the $77 billion paid by the government for physician services through the nation’s senior citizens healthcare program.

ABC News reports Medicare claims the database is considered the richest trove of information on doctors. Financed by taxpayers, the CMS data has curiously remained off limits to the public for decades. The American Medical Association, which has long opposed release of the Medicare database, is warning it will do more harm than good.

On the other side, employers, insurers, consumer groups, and media organizations pressed for release, arguing the data could help guide patients to doctors who provide quality, cost-effective care. A federal judge last year lifted the main legal obstacle to release, and the Obama administration recently informed the American Medical Association it would open up the claims data.

Researchers are keenly interested in doctors' decision-making patterns to help determine what drives the nation's $2.8-trillion-a-year health care system. Physicians act as the main representatives of patients, and their decisions about how to treat determine spending within the system.

Modern Healthcare described the database, saying it includes 9.2 million lines detailing transactions worth $77 billion by 880,000 physicians and physician practices certified to collect from Medicare. It includes physicians' names and office locations, the exact services for which they billed Medicare, the average payments for each service, and the number of patients who received each service.

As expected, the most common Medicare payout was for the $70 doctor office visit, followed closely by the $100 office visit. Taken together, the five levels of visits known as evaluation-and-management services cost Medicare nearly $11 billion in 2012.

The entire data set, including all payments to doctors under the Medicare Part B program, is now public information. The data will keep analysts and media outlets busy for years to come as the annual releases begin to reveal changes in practice patterns over time.

Some preliminary analysis by Modern Healthcare revealed that:

  • On average, doctors get about 19 percent of their money treating Medicare patients through copayments, deductibles, and secondary-insurance. For a $70 evaluation visit, Medicare usually pays about $49 and the patient or their private insurer covers the rest.
  • Many of the highest-paying Medicare physician procedures are actually for the purchase and administration of drugs.
  • The busiest Medicare physician practice in America may be in Michigan. The data shows an Ann Arbor primary care doctor submitted bills for treating more than 207,000 Medicare patients in a single year, the highest such figure in the nation. That doctor's physician practice was reimbursed $7.6 million by Medicare, according to the data.
  • Medicare paid a tiny group of doctors $3 million or more apiece in 2012. One got nearly $21 million.

Meanwhile, analysis by the AP found that a small sliver of the more than 825,000 individual physicians in Medicare's claims data base – just 344 physicians – took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion.