Current data released by the Centers for Medicare and Medicaid Services (CMS) confirms that Medicare paid $77 billion to physical therapists, chiropractors, nurse practitioners, individual providers, and physicians in 2012. However, the American Medical Association has been in litigation for decades and strongly objects to releasing this information to the public. Nevertheless, for the first time, the facts are no longer private; they warrant scrutiny, while offering some transparency.
Medicare covers close to 50 million disabled and elderly Americans. Doctors are not required to accept individuals on Medicare; however, excluding pediatricians, 91 percent of doctors do accept them as patients.
The data reported by CMS shows a list of healthcare providers who offer services for Medicare Part B patients; services which include CT scans, eye exams, cataract surgery, and physical therapy, to name a few.
Medicare’s payments totaled $540 billion in 2012; two-thirds of the payments went to hospitals, with most of the money earmarked for prescription medication. The recently released data also confirms that 344 clinicians each received over $3 million from Medicare Part B that same year.
Medicare fraud and overtreatment
In 2009, the Department of Health and Human Services’ inspector general found 303 clinicians each collected over $3 million for services covered under Medicare Part B. Further review uncovered more than $34 million in overpayments in 2009. This prompted an investigation leading to two indictments and the suspension of medical licenses of three clinicians. Notably, in south Florida, an ophthalmologist received $20.8 million in Medicare payments in 2012. In addition, a California laboratory collected $190 million in 2012, as well.
Overtreatment is suspected if high-volume doctors and healthcare providers bill for more services per patient than other providers in the same community do. To help identify overtreatment and disparities, Dartmouth College’s health policy institute initiated a project entitled Dartmouth Atlas of Health Care in 1990. The researchers of this project look for regional disparities and then document the differences in frequency of a range of medical procedures between cities. For example, they found doctors in McAllen, Texas performed five times as many coronary bypass surgeries per 1,000 Medicare patients when compared to Pueblo, Colorado.
Valuable information for patients
CMS reported they would post the data on their website, www.cms.gov; however, the data is not user-friendly. Nonetheless, patients will be able to see if a doctor performs a surgery a certain way. This type of information is useful to a patient--it provides an option when deciding whether a patient wants to receive treatment from a doctor who does not modify their procedures to the patient’s explicit circumstances.
This new data will also help in revealing which doctors are abusing the Medicare system by performing unnecessary operations. Combined with fraud, unnecessary medical procedures account for one-third of the annual $2.8 trillion of U.S. healthcare expenses.