An unprecedented release of Medicare payment data is beginning to shine light on how doctors and other medical professionals are compensated for their work – and The Lund Report has started to join in the examination.
Over time, the newly available data is expected to provide insight into overtreatment, overbilling and disparities in care and costs. But experts are also cautioning the curious to take care when drawing conclusions from the dataset, which was released as a result of legislation jointly championed by senators from opposite sides of the political isle – Democrat Ron Wyden of Oregon and Republican Charles Grassley of Iowa.
The dataset contains millions of records related to payments of 880,000 health care providers. It should ultimately make it possible to conduct a wide range of analyses that compare 6,000 types of services and procedures provided under the Medicare Part B Fee-For Service Program. But the complexity of Medicare means it will take weeks or months to fully analyze the data release, according to Association of Health Care Journalists board member Charles Ornstein, a Pulitzer Prize-winning reporter.
The Centers for Medicare and Medicaid Services added this caution with its data release: “Of particular importance is the fact that the data may not be representative of a physician’s entire practice as it only includes information on Medicare fee-for-service beneficiaries. In addition, the data are not intended to indicate the quality of care provided and are not risk-adjusted to account for differences in underlying severity of disease of patient populations. “
The Lund Report has extracted the roughly 90,000 data records pertaining to $508.5 million in total payments to more than 10,000 Oregon medical providers
The data show that the largest recipients of Medicare Part B payments in Oregon are organizations. The top 10 payment recipients in 2012 were:
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PeaceHealth, receiving $7,430,809.09
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LifeFlight Network LLC, $7,005,149.58
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American Medical Response Northwest Inc, $6,507,232.53
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Interpath Laboratory Inc., $5,787,590.37
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Westlog Inc. $3,478,432.70
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Legacy Laboratory Services LLC, $3,384,877.26
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Metro West Ambulance, $2,997,092.49
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Mercy Flight Inc., $2,804,365.00
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Dr. Rebecca Callis $2,708,094.41
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Dr. Jeoffrey Rinkoff $2,226,882.23
Callis, a rheumatologist from Salem, told the Statesman Journal newspaper via email that the payments she received do not reflect her profits, and that much of the money went toward overhead costs. Callis billed Medicare for a total of 114,575 distinct medical services or procedures– no other rheumatologist billed for more than 29,000 separate services or procedures. That figure does not show how many specific non-Medicare services any doctor provided – some doctors see few, if any, Medicare patients, while others primarily treat those with Medicare coverage.
Rinkoff, the 10th highest paid medical provider in Oregon, is one of a number of ophthalmologists to rank high for Medicare Part D payments – apparently reflecting the fact that these specialists are more likely to bill the government program for the drugs they provide, sometimes at a profit.
Click the attached spreadsheet for the full list of total payment information. LINK HERE
The data can also show how Medicare payments for a single procedure vary across the state. For example, The Lund Report looked into a common procedure that was billed in both rural and urban areas – ophthalmologist code 66821, a type of vision corrective surgery known as “YAG capsulotomy.”
The figures show that prices can vary widely across geography and by doctor. In Salem one provider was paid an average of just $44.11 for this procedure – by far the lowest compensation reported for the procedure in Oregon – while another was paid $197.36. Providers who received some of the lowest reimbursements were located in Grants Pass, Hermiston, Klamath Falls as well as Salem. Those paid the most were in Eugene, Salem, Portland and Bend.
See the attached spreadsheet for details.
Courtney can be reached at [email protected].
Comments
Medicare Payments
These only include payments to patients covered by fee for service (i.e traditional) Medicare. I don't believe they include MedicareAdvantage payments. Oregon, especially Portland, has very high Medicare Advantage penetration. This makes it difficult to compare across states or communities.
Reply
Medicare Advantage plans in Oregon tend to be of higher quality than national average. Kaiser and Providence are both 5 STAR plans, only 19 in the US. Payments will vary, but in contrast to traditional Medicare, frequently have a more significant vomponent based on quality or efficiency. Payments to primary care are probably significantly higher than traditional Medicare, but specialists and hospitals still consume the bulk of payments.
This data must be taken with a grain of salt in a state where managed-care plans and Medicare Advantage is prevalent. As Ornstein reports:
This data covers services and treatments provided by doctors and other health professionals who treated the 33 million beneficiaries in Medicare Part B in 2012. It doesn’t include expenses incurred by the 13.6 million people in Medicare Advantage plans (managed-care plans) in 2012 nor does it include any private insurance costs/payments. Moreover, this data doesn’t cover payments for inpatient hospitalizations, skilled rehabilitation, durable medical equipment or prescription drugs.