Medicare data gives unprecedented look at reimbursements
Maine doctors and health care providers received around $300 million from Medicare’s fee-for-service program in 2012, around 3.8% of the nearly $77 billion spent nationwide through the program, but trends revealed by the massive and unprecedented data released Wednesday from the federal Centers for Medicare and Medicaid will likely take weeks to study.
The Portland Press Herald reported around 14 Maine doctors received more than $1 million each in payments from Medicare in 2012, and 37 received more than $500,000. Gordon Smith, executive vice president of the Maine Medical Association, told the newspaper that the look at compensation for individual doctors and medical providers indicates more about costs and less about a doctor’s income.
In the case of the top-paid health care providers, all were in three specialties: ophthalmology, hematology/oncology and rheumatology. Eight of the 14 doctors getting more than $1 million in payments through the Medicare Part B program were ophthalmologists, whose most common service was injection of a drug called Lucentis to treat macular degeneration. Medicare covers a large portion of the cost of the drug, which is one of the most expensive at around $2,000 per injection per eye, the newspaper reported. The New York Times reported that ophthalmologists were the biggest recipients of Medicare money in 2012 nationally, and Lucentis accounted for around $1 billion of the spending in 2012.
Dr. Geoff Gratwick, a state senator from Bangor and practicing rheumatologist, said that some of the numbers for his practice, showing $800,000 in reimbursements for 30,792 procedures in 2012, are incorrect. Reuben Allen, a consultant representing rheumatologists, including the top-reimbursed Dr. Robert Sylvester of Lewiston, said that of the $2.4 million Sylvester received in 2012 through Medicare, around $1.84 million went directly to biologic drugs.
Charles Ornstein, a reporter with the investigative news outlet ProPublica, said in a blog post about interpreting the data at healthjournalism.org that there are many reasons, other than fraud, that an individual doctor may receive large payments from Medicare. Those reasons include a doctor serving mostly Medicare patients, providing services reimbursed at higher rates than typical office visits or having other professionals billing services under his or her Medicare number.
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