Tuesday, April 15, 2014

What the Medicare Numbers Reveal ― and What They Don’t

By Bradford W. Holland, MD
Waco Otolaryngologist  

On Wednesday, April 9, the Centers for Medicare & Medicaid Services (CMS) did something they have never done before. They released information detailing how the $77 billion that Medicare spent to pay physicians for their services in 2012 was distributed among the 880,000 providers in the U.S. This caused a small uproar in the media (which is already dying down) about how much certain physicians were paid in that year. However, it quickly became clear there were a lot of misconceptions about what the numbers mean. So, here's a few thoughts on what we learned from this new information.

The information released is good information. It is accurate and reflects data points the public and watchdog agencies ought to be monitoring. The government, as a massive (and unfortunately, growing) payer in the health care market should be transparent in reporting its payments. The data may, as expected, help all of us weed out those bad seeds who fraudulently bill the government for services they don't provide. Believe me, doctors join patients in wanting to end Medicare fraud completely.

But one thing the data do not show is how much your doctor earned. Consider a standard corner gas station, which might sell $4 million worth of gas in a year. Does that mean the owner is a millionaire? Well, considering that the owner probably paid at least $3.75 million for the gas — then has to pay rent, electricity, wages for staff, etc. You can see that such a number really doesn't tell you anything about how much the gas station made in net dollars.

The same holds true when trying to interpret what these dollar figures mean about your physician's pay. While you can see how much your doctor was paid by CMS, it really has nothing to do with how much your doctor actually brought home in the form of a paycheck.

There is one more thing you can see from this data, and that's how poorly Medicare pays physicians for their services. My practice charges $122 for a comprehensive hearing test, performed by a master or doctor of audiology, and takes 15-30 minutes. On average, Medicare paid us $22 for the test. We charge $361 to perform a laryngoscopy (inserting a camera through the nose to look at the voice box), but Medicare paid $83. And when we perform a swallowing test with an x-ray machine and barium, we charge $338 but only get $63. Numbers like this show why senior citizens are having a hard time finding doctors. Medicare doesn't pay enough to even cover the overhead of these and most other procedures. That's a real problem, not only for physicians, but for the patients on Medicare whom we are trying to treat.

Truth be told, the data show that Medicare paid, on average, and across the entire United States, about $57 to the physician for every office visit. $57. Now you can't even have a stopped up toilet inspected by a plumber for that much, let alone have any plumbing really fixed. Do senior citizens on Medicare really expect that their doctor is paid less to listen, examine, diagnose, and treat their health problems than a plumber charges for a simple toilet clog? Most Medicare patients are aware of these discrepancies, and are generally sympathetic to their physician's plight, but really can't do anything about it. Senior citizens are being caught between a rock and a hard place in this federal Medicare system, and one thing is for sure: It is not their fault.

Let me say that I, like most physicians, greatly enjoy taking care of seniors, despite having to deal with Medicare. They are some of my favorite patients, and I feel a debt of gratitude to their generation to see them, treat them with compassion, and yes, learn from them. Caring for seniors is one of the most rewarding parts of being a doctor. I don't want that to end, but the predicament I'm in as a private practice physician is making caring for Medicare patients more and more difficult. And so, as something else that will perhaps come of this new data released last week —we need to ensure the health of our nation's seniors is not further jeopardized by the Medicare payment system currently opened to scrutiny by the public. I hope a better future for Medicare awaits us all.

1 comment :

  1. I have been practicing since 1980 and have seen all kinds of changes in medicine. I for one applaud that CMS released the information to the public! I looked at my data and smiled because it represented an accurate picture of my practice. I was appalled at the data for some of my colleagues. It actually confirmed what nobody ever talks about at TMA or my local medical society. We have a massive internal problem! There is a reason why we are being scrutinized more and more. Too many physicians have utilized loop holes in the coding and payment systems to establish procedure mills. How does a general/family practice conduct a high percentage of cardiac echoes for a large majority of their patients? By some miracle does that one doctor attract all these cases compared to other 10 doctors in the same specialty in the same town? In reviewing some of the lab procedures for some of these practices, it is there for all to see that one specific test that is handsomely rewarded is ordered at a frequency that is not the norm for again 1 out of 10 practices of similar specialty. A quick study of the codes and payment edits and you can quickly see that a loophole is being exploited. Too many practices have lost the meaning of "medically necessary" and instead looked at it as "billable." I agree that Medicare has reduced its payment substantially but do not blame Medicare. We doctors and hospitals CAUSED the problem! We took a system that was first established on an honor system where we submitted charges and were paid for those charges. There was, in my opinion, a correction to reality initially when fees came down to better reflect that actual value of those services. Instead of AMA, TMA and our specialty societies helping us address these realities, we collectively instead resisted the changes because it hit us all in the pocketbook and we whine about unfairness and carry on like our politicians about government intervention. The fact of the matter is that we are not deserving of taxpayer money. We have proven as a group that we are incapable of being good stewards with taxpayer money. For all of my other colleagues who also smiled when they reviewed their data knowing they can hold their head high....we too failed because we did not stand up against those within our midst who clearly demonstrated a disregard for a system that has helped millions and millions of people. I can only now pray that the leadership of TMA will soon decide to stop the silly campaigns, the Calendars of Doom, the political non-sense and FINALLY lead. AMA does not represent the majority of physicians nation-wide and if we continue on this course neither will TMA be the voice of Texas physicians.

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