At last, Medicare by the numbers

The News TribuneApril 15, 2014 

The nation needs to know how much Medicare money is getting wasted or otherwise misspent. Last week’s release of billing information – connecting dollars to doctors – may help explain why the United States spends as much as it does on health care without getting more healthiness to show for it.

At first glance, it looks like some specialists – especially ophthalmologists, oncologists and pathologists – are getting astoundingly rich. Four thousand doctors billed Medicare Part B for more than $1 million each in 2012, not including their billings to private insurers. Among them were 879 eye doctors. Greedballs, right?

That impression is precisely why doctors and the American Medical Association fought for years to prevent the release of the data. They assumed the public would react to the headlines and conclude that the medical profession was steeped in avarice.

So let’s provide the counter-narrative. Gerald Ho, a Los Angeles rheumatologist interviewed by the Washington Post, is a good place to start.

Ho received more than $5.3 million in Medicare payments in 2012. But, as he told the Post, “I am not pocketing $5.3 million.” Ho said he runs three offices, pays a staff of 40 and spends millions on the genetically engineered drugs he administers to his patients. All of that winds up in the billing.

Those monster Medicare payments, in other words, often reflect monster overhead costs. In some cases, multiple doctors in a group practice charge Medicare through a single doc’s billing code. There appear to be reasonable explanations for many of the seemingly stupendous reimbursements.

As for the excellent money most specialists undeniably make, do you want the guy slicing your eye open to remove a cataract to be getting $15 an hour?

Point taken, AMA. Still, the information does point toward ways the country could be getting more out of its health care dollars.

The system is set up to reward quantity, not quality, of treatment. When specialists do more procedures, they make more money. When they administer more expensive drugs, they get a higher cut – even if expensive drug isn’t more effective than a cheaper alternative. Now there’s a way to spot patterns that could suggest solutions.

One mystery of American health care is why some procedures are performed far more frequently – or cost far more – in some regions than in others. Maybe the Medicare data will help explain this.

Medicare now is on a ruinous spending trajectory. Unless its money is spent more wisely, the elderly will ultimately see their treatment options cut or else the uncontrolled spending will crowd out other national priorities.

Hence the need for details. Any doctor will tell you that you can’t treat an illness without seeing the patient.

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