Medicare Records Provide Tantalizing New Details Of Payments To Doctors

Medicare’s release Wednesday of millions of records of payments made to the nation’s doctors comes as the government is looking to find more cost-efficient ways to pay physicians, particularly specialists.

The federal government published data tracing the $77 billion that Medicare paid to physicians, drug testing companies and other medical practitioners throughout 2012, and what services they were being reimbursed for. The data cover 888,000 different practitioners. More than 6,000 procedures are included, and the full database is so large that it requires statistical software to analyze it. While the database provides tantalizing details, showing for instance the huge amount ophthalmologists are paid to treat a common eye disorder, experts cautioned that the data can be easily misunderstood and could lead to some doctors’ incomes being unfairly pilloried.

The release comes 35 years after a court-issued gag order that prevented anyone from revealing Medicare Part B payments to individual doctors, and advocates for more transparency in health care payments heralded the release as a leap forward. “Taxpayers have the right to understand what is being paid for and how it is being paid for,” said Jonathan Blum, principal deputy administrator for the Centers for Medicare & Medicare Services.

He asked for the public to comb through the information to help find waste and fraud and also encouraged researchers to use it to try to determine why spending on health care for the elderly varies so much in different parts of the country. This could replicate on the physician level what the Dartmouth Atlas of Health Care has been doing for decades in showing variances in Medicare’s hospital spending.

“The uses of this data can and will go significantly beyond the identification of fraud, waste and abuse,” said Niall Brennan, the Medicare official who oversaw the development of the database.

The release also comes at a propitious time for the government’s effort to refashion the way America’s health care system is financed. Earlier this year Medicare invited adviceon how it should devise new ways of paying specialists to replace the current system, in which doctors are paid a set fee for each visit or procedure. The goal of these approaches is to remove the financial incentive for practitioners to do more services.

Under the authority of the federal health care law, the Obama administration has already launched experimental programs aimed mostly at hospitals and large medical groups. There are hundreds of trial efforts under way to pay medical practitioners a set fee to treat a defined ailment, such as replacing a knee, with the fee covering all aspects of the care from before the operation through the recovery and any setbacks.