Medicare Data Reveals Top Billing Docs

Buckling to calls for transparency and a Wall Street Journal court case requiring the agency to provide public access to physician billing records, the Centers for Medicare & Medicaid Services (CMS) released a database containing transactions worth $77 billion by 880,000 physicians and physician practices certified to collect from Medicare, reports Modern Healthcare. Included in the data set are individual physician names and locations, the services that were billed and paid, and the number of patients who received the services.

Heading up the list, with the largest single share of physician billings in 2012, were routine office visits—but that only amounts to one-seventh of the $77 billion paid by the government for physician services.

The highest paying procedures, according to the data, are attributed to the purchase and administration of medications, especially cancer medications. For example, it lists the administration of the prostate drug Provenge at $25,730. The code used to identify the procedure accounted for a dozen of the 20 most expensive physician procedures at practices across the country in 2012.

Physician groups like the American Medical Association, and individual physicians, voiced concern because data released without explanation or context could mislead the public.

In particular, an analysis of the database by The Washington Post revealed that a hematologist-oncologist in Newport Beach, CA, had received more than $9 million in reimbursements, ranking him as a top 10 biller of Medicare in 2012.

The physician, Minh Nguyen, explained the high total was because all the chemotherapy drugs for his five-physician practice are billed under his name.

He told the Post that, “It looks like I’m getting paid $9 million, but it’s a pass through. The majority of the billing goes to pay the drug companies.”

Nguyen said the data could illuminate the challenge experienced by oncologists around the country who are struggling with rising drug costs. Typically, the practice must purchase drugs up front — at a cost of about $25,000 per treatment – and then wait weeks or months for Medicare or insurance companies to reimburse them.

Jonathan Blum, principal deputy administrator at CMS wrote on a blog post that releasing the data gives the public “unprecedented access to information about the number and type of health-care services” doctors provided during the year.

The Medicare program is the nation’s largest medical insurer and the data that are shared will shed some light on questions about health care costs as the US confronts rising medical bills. It will also undoubtedly, keep analysts and media outlets busy for years to come as the annual releases begin to reveal changes in practice patterns over time.