On June 1, 2015, the government released the second year of Medicare payments to physicians, hospitals and suppliers. The highest-paid specialists were radiation oncologists, who received an average of $403, 512 from Medicare for their services. That was closely followed by dermatologists ($331, 108), vascular surgeons ($329, 874), and ophthalmologists ($326, 621).
Medicare paid all physicians $90 billion in 2013, up 17% from $77 billion in 2012, CMS (Centers for Medicare and Medicaid Services) officials reported on June 1, 2015. The payments went to about 950, 000 doctors, nurse practitioners and other individual healthcare providers who participate in the program. That was up from 880, 000 providers in 2012.
Joint Replacement Top Procedure
Joint replacement was the most common hospital procedure that Medicare paid for in 2013, accounting for nearly 450, 000 inpatient admissions and $6.6 billion in payments, or about $13, 000 per admission. Total knee replacements led the list. Replacement procedures averaged about 12 per 1, 000 Medicare beneficiaries with surgery rates highest in the Midwest and Rocky Mountain states. The average hospital charged around $54, 000 in 2013. Medicare, on average, paid around $12, 000.
Charges Up, Reimbursements Steady
Overall, the data reportedly showed that hospitals raised their billing prices by 10% between 2011 and 2013, while the amounts paid by Medicare stayed flat.
Physician payments accounted for less than one-fifth of Medicare’s 2013 net outlays of $492 billion, which rose from $466 billion in 2012. Payments to hospitals for the top 100 inpatient stays cost Medicare $62 billion in 2013, while the rest went for drugs, privately run Medicare Advantage plans and other program costs.
There was a significant change from how the data was reported last year. This year the government differentiated between what it paid physicians for their services and what it paid to cover the costs of drugs. Some physicians had complained that they were portrayed as exorbitant billers because the cost of drugs was included in what Medicare paid them.
For example, medical oncologists, who treat cancer patients with chemotherapy and generally coordinate their care, received an average of $181, 747. The previous year’s data showed them as some of the top Medicare billers, but that largely reflected reimbursements for the cost of drugs—an average $473, 926 in 2013. The physician who received the most from Medicare was Anne Greist, M.D., a co-founder of the Indiana Hemophilia & Thrombosis Center. She received $28 million in payments, but nearly all of that—$27.9 million—was for reimbursements for drugs.
The American Medical Association was happy about separating the drug payments from physician reimbursement, saying it “remain[s] concerned that the 2013 data still has significant shortcomings.”
“Specifically, the data released today does not provide actionable information on the quality of care that patients and physicians can use to make any meaningful conclusions, ” stated an AMA press release. “It also does not provide enough context to prevent the types of inaccuracies, misinterpretations, and false assertions that occurred the last time the administration released Medicare Part B claims data.”
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