Wednesday, April 9, 2014

Medicare releases data - Interesting!

ABC News has released an Associated Press story regarding reimbursement to physicians by the Medicare program. It is an interesting read. There are multiple iterations of it on the web this afternoon. 

Essentially, Medicare has released the records of who it paid, and how much, in 2012. One Ophthalmologist in Florida was paid $20.8 million. If you worked twenty-four hours per day, three hundred sixty-five days per year, you could clock 8,760 hours. That $20.8 million would not seem so high if I told you that this is only $2,374 per hour ($20,800,000/8,760). Of course, if you only worked five days a week, took a two week vacation, observed all 10 of the federal holidays, thus working 240 (48 weeks x 5 days) days, even assuming them to be 12 hour days, then this comes out to 2,880 (12 x 240 =) hours. Dividing the $20.8 million by that amounts to only $7,222.00 per hour. 

The first thing we should get from this is that the payments to this Ophthalmologist are for care provided at the business he runs. Some, perhaps most, of the services were provided by employees that may have been other physicians, assistants, nurses. It is also possible that some portion of these reimbursements are for supplies or medication provided in the clinic setting, not payment for services per se. These caveats are likely true for all of the "top paid" doctors. The Associated Press ("AP") grouped them in the "top" by using an arbitrary figure of "greater than $3 million." This was a figure used by an audit last year, and the AP just went with the figure. A total of 344 physicians were paid this much or more by Medicare in 2012. Of that 344, 25% were here in Florida. 

According to the AP story, Florida is "a state known both for high Medicare spending and widespread fraud." That seems a bit harsh. Five states (Florida, California, New Jersey, Texas and New York) accounted for 193 of the "over $3 million" group. More than half of the 344 from just five states. The median payment, however, was much lower, about $30,265.00. 

There are groups and individuals that decry the release of this data. (Medpage Today is running a survey to gauge public reaction to the data release; the comments on that survey are interesting also). There are claims that we (the public) cannot understand the data and that we will jump to erroneous conclusions. I am reminded of a 1927 Louis Brandies quote in Whitney v. California. He remarked that the remedy to be applied is more speech, not enforced silence."

I suspect there is more to these figures that meets the eye on initial examination. I suspect that there may be ways to manipulate this data to support any argument one might wish to make. In the end, however, I think it is a good thing that this data is out there for people to consider. 

If it is inaccurate or misconstrued, the solution to that problem is more people analyzing it and more perspectives being expressed. As the article notes "decision-making patterns are of intense interest to researchers who study what drives the nation's $2.8 trillion-a-year health care system." (did I read that right, it said "trillion" right?)

That said, if I could make $7,222.00 per hour, I am not sure I can honestly tell you how many days I would work each year. I suspect I would not be "full time."

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