The Department of Health and Human Services today released a large set of records that offer an "unprecedented" look at just how lucrative the Medicare program is for many physicians and other health professionals. "Currently, consumers have limited information about how physicians and other health care professionals practice medicine," said HHS Secretary Kathleen Sebelius "The data released today afford researchers, policymakers and the public a new window into health care spending and physician practice patterns." The data is spread across numerous large (100MB+) Microsoft Excel files and allows a straightforward comparison involving 6,000 different types of services and procedures.
The Washington Post has already given the documents a quick scan. Among the standouts is a Florida-based cardiologist who pocketed $18.1 million in 2012; his main procedure involved putting stents in patients. And there's a pathologist in New Jersey who took in $12.6 in Medicare payments for "performing tissue exams and other tests." However, there's no way to be certain whether doctors are scamming the government-run program based on numbers alone.
Important re: Medicare data--It's partial payments not profits. Big billers may have high overhead and small margins http://t.co/JlN5hqHwRP— Christopher Weaver (@cdweaver) April 9, 2014
HHS admits the data may contain more than a few errors. And some practitioners may have an unusually high number of Medicare patients, which would distort the total some. As the Post notes, they might also perform services that ultimately direct a large portion of Medicare money to outside parties — pharmaceutical companies (for expensive medications) or manufacturers of medical equipment. Based on that thinking, the Post ran its own analysis of the data and concluded that only 23 of the 4,000 biggest billers personally made $1 million or more thanks to Medicare. And doctors are already concerned that most people will assume the worst without actually understanding the figures they're seeing. Speaking to the Post, one health professional said, "When they throw out numbers like this without any context, it’s going to be misconstrued by the public."
But the primary reason HHS spilled the large trove of documents relates to transparency. ""Data transparency is a key aspect of transformation of the health care delivery system," said Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services. And when you're being more transparent, it's easier to spot potential cases of fraud and questionable charges. Several of the top billers have already drawn unwanted attention from government inspectors.