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Continued: Medicare payments to doctors reveal specialists as big winners

The data reflects only payments from Medicare’s Part B fee-for-service system and not for the Medicare Advantage program, which allows the elderly to enroll in managed-care plans. That is significant in Minnesota, where 47 percent of the state’s more than 800,000 elderly Medicare enrollees purchased Advantage plans from health insurers.

And the data reflects revenues — not take-home profits — because doctors use it to pay for their offices, equipment, prescriptions, nurses and other expenses. Depending on the specialty and practice, 50 percent to 70 percent of revenues could go toward expenses.

Where the value is

Despite the limitations of the data, health care experts believe it will provide value to the public. While doctors are paid by Medicare at fixed rates, the database lists what they charged — their sticker prices for services. And that could be useful to patients along with data showing which doctors performed the most procedures.

The data could also help identify doctors who are performing outdated procedures or ordering excessive tests. The Associated Press reported Wednesday that 344 U.S. doctors received more than $3 million from Medicare Part B, and that 2 percent of physicians accounted for one-fourth of payments.

“We know there is waste in the system, we know there is fraud in the system,” said Jon Blum, deputy CMS administrator. “We want the public to help identify spending that doesn’t make sense.”

That said, much of the money goes for garden-variety health care. In Minnesota, more than $98 million of the $449 million in Part B payments to doctors was for office visits.

Municipal and private ambulance services also were major recipients. Gold Cross in Rochester and Allina Health in Minneapolis each received more than $6 million for emergency medical transportation and life support care.

Ophthalmologists in general were among the highest-paid by Medicare in Minnesota. Dr. Alan Downie of Stillwater received $1.8 million from Part B in 2012 — 87 percent of it was to administer the injectable ranibizumab, which is sold under the brand name Lucentis.

Williams, the Edina ophthalmologist, said he wasn’t surprised to see specialists in his profession receiving so much from Part B. At least 60 percent of his clinic’s revenues come from Medicare because retinal conditions such as macular degeneration are most common in the elderly; physicians treating younger patients would receive more of their revenue from private insurance and less from Medicare. In addition, he said, his group mostly takes referrals of patients who are already on the path to blindness.

Costs have increased with the advent of brand-name drugs that treat these conditions, but Williams said the payoff has been obvious.

“A lot of these elderly people who were losing their vision, we did our best, but after a while they would lose their vision,” he said. “Today, using this medication, it basically stops the disease in its tracks.”

 

jeremy.olson @startribune.com • 612-673-7744

glenn.howatt @startribune.com • 612-673-7192

  • Specialty Payments

    to Minnesota Providers

    Internal medicine $57.8 million

    Family practice $53 million

    Ophthalmology $50.2 million

    Diagnostic radiology $50 million

    Ambulance services $37.5 million

    Pathology $23.4 million

    Cardiology $21.5 million

    Nurse practitioner $21.1 million

    Radiation oncology $19.2 million

    ER medicine $18.9 million

    Ambulatory surgery $17.9 million

    Orthopedic surgery $17.8 million

    Dermatology $17.7 million

    Hematology/oncology $14.2 million

    Clinical laboratory $14 million

    Neurology $13.2 million

    Physician assistant $12.7 million

    Chiropractic $11.5 million

    Physical therapy $10.8 million

    Nephrology $10.8 million

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