Short Takes On News & Events

What Consumers Can Learn From Medicare Payment Data

By KHN Editors

April 10th, 2014, 8:37 AM

Wednesday the federal government published details on Medicare’s $77 billion in payments to physicians, drug testing companies and other medical practitioners during 2012.

KHN’s Jordan Rau, who reported on what can be learned from the newly-released data, discussed Medicare payments to providers with NPR’s Melissa Block on “All Things Considered” Wednesday night. Audio of that conversation and a transcript follow.

NPR’s MELISSA BLOCK:  [Wednesday], for the first time, the agency that runs the Medicare program has released data showing how much doctors get paid by the government for everything from office visits to surgical procedures to chemotherapy. It’s a massive amount of data that may help patients learn more about how their doctor practices medicine.

The data are sure to provide some interesting insights, but there are also limits to how much can be learned. And joining me in the studio now to talk more about this is Jordan Rau with our partner Kaiser Health News. Jordan, thanks for coming in.

KHN’s JORDAN RAU: Glad to be here.

MELISSA BLOCK: Why don’t you tell us first just exactly what the government released today in this massive data dump?

JORDAN RAU: They put down an entire year’s worth of billing that doctors did to Medicare, and it’s huge. It’s 880,000 different doctors billing about $77 billion, and it’s on over 6,000 different procedures — everything from an office visit to a very complicated chemotherapy to the use of a helicopter or an airplane to transport a patient.

MELISSA BLOCK: And just to be clear, this is doctor information. It doesn’t include patient names.

JORDAN RAU: There’s no patient information. In fact, the release was designed to protect patient privacy, and the way that they did that was, aside from obviously not naming the patients, they only included procedures where a doctor had done it a bunch of times, so that you could not be identified even by the nurse or the receptionist in the actual doctor’s office.

MELISSA BLOCK: We mentioned this is being released for the first time. Why wasn’t it released before now?

JORDAN RAU: Well, for three decades, the American Medical Association has blocked the release of this data through a court order. They didn’t want it to come out because some of it, way back during the Carter administration, was inaccurate. In fact, one Michigan doctor was described as having billed $150,000 when he actually billed $15,000. And so they’ve been successful in that case until recently when The Wall Street Journal sued and was able to overturn that injunction.

MELISSA BLOCK: There are a number of headlines run that are framing the conclusion of these data as being that a very tiny sliver of doctors, two percent, are accounting for something like 25 percent of the total Medicare payments, that $77 billion number. Does that seem like a fair characterization to you of what you’re learning?

JORDAN RAU: Well, to some extent, it’s not surprising. You’re going to have some doctors that do an enormous amount very expensive procedures on the spine or neurologists or transplants, and so those are going to take up a large amount of the bills. But overall, I’m not sure that that’s going to tell us anything that’s that useful. It’s not that a huge amount, 1 percent or 2 percent, are just ripping off the system and driving around in expensive Maseratis.

MELISSA BLOCK: So what is the point then? What’s the idea behind releasing these numbers?

JORDAN RAU: Well, to some extent it’s the government’s biggest effort at crowdsourcing. I mean, they want everyone to dig in and look for waste, fraud and abuse and questionable billing practices. But the other thing is to shine a lot of light on where Medicare’s money goes to show that some doctors are performing really, really expensive procedures when there might be cheaper ones; to see why, in some areas of the country, doctors are spending a lot more of Medicare taxpayers’ dollars than for doctors in the other areas of the country doing the exact same thing.

MELISSA BLOCK:And from the patient’s perspective, if I were to be looking at these numbers trying to figure out anything about doctors or a procedure I might be interested in, what would I learn?

JORDAN RAU: Well, you probably wouldn’t learn that much. There’s no quality information to show how well a surgery actually turned out. There’s a possibility that a lot of what a doctor did is not for Medicare, so you might not even know that they did a lot of stuff for private insurance. It might be useful, theoretically, if you love to spend time with an Excel spreadsheet, it might be helpful to take a look and find doctors that do something that’s very unusual. If you happen to be looking for a particular type of transplant or chemotherapy, it might help winnow that down. But otherwise, I would be very careful about drawing any conclusions about any individual doctor from this.

MELISSA BLOCK: Jordan Rau is a reporter with Kaiser Health News. Jordan, thanks.

JORDAN RAU: Thank you.

2 Responses to “What Consumers Can Learn From Medicare Payment Data”

  1. evan says:

    Secrets, secrets, secrets! Exactly the way Republicans like it! That’s why Republicans hate the Affordable Care Act (ACA). Republicans are like cockroaches operating in a dark kitchen. Then, along comes the ACA to turn on the kitchen lights and all we see are tons of Republican cockroaches scattering to try to find a dark place to hide! Republicans! The Congressional scumbags that keep repeatedly voting to repeal the ACA and return working poor people to the healthcare status quo that we suffered with prior to 2010. A vote for a Republican means a vote to repeal the ACA and send working poor people back to the dark ages!

  2. Penelope says:

    I wonder if this data will bring to light discrepancies between what doctors bill and how they are actually reimbursed? With the tangle of Medicare loopholes and regulations, a lot of physicians aren’t reimbursed by Medicare in ways they feel they are entitled to. The AHA publishes finding of this nature every year: always, always, always, getting fair government reimbursement for services is a top concern for physicians and hospital executives. Maybe this data will finally shed some light on those concerns?

Share