One doctor was paid nearly $21 million in 2012 from Medicare, according to an Associated Press analysis of the physician payment database that the Obama administration made available to the public early Wednesday.
Topping the list was Salomon Melgen, an ophthalmologist in Florida, who received $20.8 million from Medicare, according to the AP analysis. Melgen, who is also accused of fraud, is among a select few who received multimillion-dollar payments. Only 344 of the 825,000 individual physicians in the Medicare claim data base were paid at least $3 million each, the AP found.
Overall, the AP found that Medicare paid individual physicians an estimated $64 billion in 2012.
Despite physician opposition, the Centers for Medicare & Medicaid Services released the information as part of the Obama's administration move to make the data more transparent. "We plan to provide the public unprecedented access to information about the number and type of healthcare services that individual physicians and certain other healthcare professionals delivered in 2012, and the amount Medicare paid them for those services," CMS Principal Deputy Administrator Jonathan Blum said last week in an announcement. "Providing consumers with this information will help them make more informed choices about the care they receive."
But the AP analysis of the data shows that many Medicare patients may experience shock when they learn just how much their physicians earn. "A lot of people on Medicare will drop their coffee cups when they see how much their doctors are making," Jean Mitchell, a Georgetown University economist, told Businessweek, FierceHealthcare reported on Tuesday. "People don't recognize that medicine is a business; the way you make money is by doing procedures. You don't make money telling people to eat right and exercise."
However, patients who want to learn how much their doctors were paid will have to wade through the huge database. The CMS data is available in two formats: Excel spreadsheets split by provider last name or by a tab-delimited file format, which requires users to import the information into a database. CMS also created two summary tables that aggregate information by physician or other provider that billed Medicare Part B in 2012 and data that groups the information by state and HCPCS code.
But several leading physician group opposed the release of the information.
The American Medical Association (AMA) argued in a statement Wednesday that the data dump without context will "lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences."
"Thoughtful observers concluded long ago that payments or costs were not the only metric to evaluate medical care," AMA President Ardis Dee Hoven, M.D., said in the statement. "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."
And in a statement emailed to FierceHealthcare this morning, Susan Turney, M.D., president and CEO of the Medical Group Management Association (MGMA), said the release is detrimental to patients and physicians without proper context and safeguards in place.
"MGMA is troubled about the potential for unintended consequences as a result of the release of this type of data and the effect it may have on Medicare beneficiaries," she said. "This release could result in patients making decisions about their care based on faulty assumptions about physicians. Claims data are not a proxy for quality, especially when provided in isolation, from a single payer."
Furthermore, Turney said the association is concerned that the information release may make providers susceptible to fraud. "Physicians should have had the opportunity to review the data before it was m-ade publicly available in order to modify or appeal any inaccuracies," she said.
To learn more:
- read the AP analysis via ABC News
- here's the CMS data
- read the AMA statement