Healthcare News & Insights

It’s all about transparency: Medicare reveals how much it pays each doctor

On Wednesday, Kathleen Sebelius, Health and Human Services (HHS) secretary, announced the release of millions of Medicare payment records made to physicians and other healthcare professionals. It’s a part of the Obama administration’s work to make our healthcare system more transparent, affordable and accountable. 

480890931HHS sees this as a good thing,  because consumers have limited information about how physicians and other healthcare professionals practice medicine.

“This data will help fill that gap by offering insight into the Medicare portion of a physician’s practice,” said Sebelius in a Centers for Medicare & Medicaid Services (CMS) press release. “The data released today afford researchers, policymakers and the public a new window into healthcare spending and physician practice patterns.”

Open to public

This data will allow a wide range of analyses that compare 6,000 different types of services and procedures, as well as payments received by individual healthcare providers.

In addition, it allows comparisons by physician, specialty, location, the types of medical service and procedures delivered, Medicare payment, and submitted charges.

“Data transparency is a key aspect of transformation of the healthcare delivery system,” said Marilyn Tavenner,  CMS administrator. “While there’s more work ahead, this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program.”

In addition, Jonathan Blum, principal deputy administrator for CMS, asked consumers to closely examine the data to help find waste and fraud. He also encouraged  researchers to use the data to determine why Medicare spending varies so much throughout the country, according to Kaiser Health News.

Misleading data

Experts caution, however, that the information is misleading and could be easily be misunderstood, causing doctors’ incomes to be unfairly torn apart.

Reason: The data leaves out just as much important information as it provides.

For example, the data does not include:

  • any treatments doctors do on non-Medicare patients, such as people on private insurance
  • Medicaid and those who pay cash
  • Medicare beneficiaries who have coverage through Medicare Advantage private insurance plans, and
  • various experimental payment reforms the government has initiated.

In addition, payments for some doctors may be larger than it appears in the data because they also could have billed Medicare through a combined medical practice or other medical organization.

“We should be very careful to not draw any conclusions at the low end of the spectrum,” Fred Trotter, a healthcare data expert, said in the Kaiser Health News report. “That doctor who ‘only’ performed procedure X eleven times? That probably means nothing. What the doctor is actually doing with his/her patients is just not showing up at all.”

Charles Ornstein, a senior reporter at the investigative nonprofit Pro Publica, cautioned reporters on a note published on the website of the Association of Health Care Journalists, “There are many reasons why a doctor may receive large payments from Medicare:”

  1. The doctor may treat Medicare patients exclusively, and therefore, the doctor’s payments would look larger compared to peers who also see a lot of privately insured patients (this is called a provider’s payer mix).
  2. The doctor may provide services, such as eye surgery or cancer care, that are reimbursed at higher rates than typical office visits.
  3. The provider may have other professionals billing under his/her Medicare number, which is allowed in some circumstances.

While there may be other reasons why one may question the validity of payments, no one should assume that because a number is large, a doctor has committed fraud.

To see Medicare’s database, click here.


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