A new database from the Centers for Medicare and Medicaid Services reveals which doctors had the largest Medicare reimbursements.
The database involves 880,000 doctors who received about $77 billion in reimbursements in 2012, according to the centers.
“Data transparency is a key aspect of the health care delivery system,” said Marilyn Tavenner, centers administrator, in a Wednesday news release. “While there’s more work ahead, this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program.”
Dr. Jon Prescott, a radiation oncologist, topped the list in Lorain County. Prescott had about $2.85 million in reimbursements. The database lists Prescott’s business address as the Mercy Cancer Center in Lorain. Prescott, who also practices at the Northern Ohio Regional Cancer Center in Brook Park, didn’t return calls last week.
Dr. Patrick Litam, the runner-up, had about $1.7 million in reimbursements. Litam, who didn’t return calls last week, also had the center listed as his business address. The top five doctors on the database for Lorain County all had the center listed as their address.
Jennifer Cakir, a Mercy spokeswoman, didn’t return calls Sunday or last week regarding whether the doctors are Mercy employees or just have admitting or practicing privileges at the center. Cakir also wouldn’t answer how much of the reimbursements Mercy received.
However, Cakir wrote in a Thursday email that Mercy supports greater transparency regarding the cost and quality of medical care. She said it was too early to say what impact the database would have on public understanding.
“We encourage patients to review multiple information sources to get a full picture of the factors that contribute to their care, including cost, quality and safety outcomes,” Cakir wrote.
The New York Times, which also provided a link to the database, reported Wednesday that 2 percent of doctors accounted for $15.1 billion in reimbursements, about 23.5 percent of the $77 billion. Ophthalmology, hematology/oncology, cardiology, radiation oncology and internal medicine were the fields with the biggest reimbursements.
The Times said the American Medical Association had fought disclosure in federal court for years until a judge ruled last year that the information could be made public. The AMA website said the centers were releasing the data without context, which could lead to “inaccuracies, misinterpretations and false conclusions.”
The AMA said Medicare reimbursements are based on fixed prices based on fee schedules and payments are generally, “far less than what was charged.” The AMA also noted doctors receive far less for care done in hospitals than at their offices because they don’t have to pay for overhead at hospitals.
Dr. Donald Sheldon, president of University Hospitals Elyria Medical Center, said Sunday that he supports disclosure but understands why the AMA opposed it. He said the database also needs to include data on appropriateness of procedures, quality of care and patient satisfaction. “What’s being paid is only a piece of the equation,” Sheldon said.
While doctors with high reimbursements could be performing unnecessary procedures, Sheldon said it also may be because they are good at a particular specialty and do them often. Sheldon said patients may want to have doctors with high reimbursements because they’re good at what they do.
“More can be better or more can be worse. Less can be better or less can be worse,” he said. “Do you want the doctor who took out one gall bladder last year? Probably not.”
Sheldon said he hopes the database will decrease doctors performing unnecessary procedures to earn more reimbursements. In 2013, when it was known as EMH Elyria Medical Center, the hospital paid the federal government a $3.9 million settlement for unnecessary procedures billed to Medicare between 2001 and 2006. Its then-affiliate, North Ohio Heart Center, paid $500,000.
Sheldon said doctors, hospitals, health care systems and insurers all need to do better at reducing costs for patients and taxpayers while still maintaining quality care. “You don’t want to drastically cut costs to the point where you’re cutting corners,” he said.
Sheldon said some doctors are hospital employees and receive salaries, with hospitals receiving all of the reimbursements. Some doctors in private practices receive all of the reimbursements, while some receive a combination of both. At UH Elyria Medical Center, Sheldon said the majority of doctors are not employees and are reimbursed directly by Medicare.
At the Cleveland Clinic, which has facilities in Avon, Avon Lake, Elyria, Lorain, North Ridgeville, Oberlin and Wellington, doctors are hospital employees and the Cleveland Clinic receives the reimbursements, according to Eileen Sheil, a Cleveland Clinic spokeswoman. Doctors, including Toby Cosgrove, CEO and president, are all on one-year contracts. Sheil said some may get the perception that doctors getting high reimbursements are performing unnecessary procedures, but it may be due to complex care such as cancer treatment or heart procedures.
“Our guys don’t make more money personally if they do seven surgeries or 10 surgeries,” she said. “They don’t get bonuses for anything.”
Sheil said the Cleveland Clinic posts operation outcome statistics on its website as part of transparency efforts. She said the clinic supports formation of the database, which she said will help patients make better decisions on how to spend out-of-pocket costs.
“It’s good, but it’s important that it’s in context and (patients) understand what those numbers mean” Sheil said.
Contact Evan Goodenow at 329-7129 or email@example.com.
- A new Medicare database details how $77 billion in Medicare reimbursements were distributed to more than 880,000 doctors in 2012 including in Lorain County. To find out how much doctors were reimbursed, visit go.cms.gov/Q5MTfM.
SOURCE: Centers for Medicare and Medicaid Services