Friday, April 11, 2014

Is your healthcare different today than it was yesterday?

The Center for Medicare services has released how much it paid doctors in the year 2012. The big news is that one doctor in Florida made a lot of money:

Let’s take a look at these doctors based on CMS own data:a small sliver of the more than 825,000 individual physicians in Medicare's claims data base — just 344 physicians — took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion.

So if only 344 physicians earn the top dollar out of 825,000 physicians how much did the other 824,656 physicians make?

The median payment — the point at which half the amounts are higher and half are lower — was $30,265.

While we don’t know what the other physicians made, we do know that the median amount paid to all physicians was $30,265. Medicare makes up about 30% of the payer mix for an average physician’s office. So what we can concur from this information, from the most transparent administration in the history of America, is that 30% of a physician’s revenue was approximately $30,000. Does this information in any way change how you choose a doctor?

Employers, insurers, consumer groups and media organizations pressed for release. Together with other sources of information, they argued that the data could help guide patients to doctors who provide quality, cost-effective care

An argument for releasing this information is so consumers can be better educated on choosing their doctors based on how much Medicare pays the doctor for the service provided. One piece of insight already data mined from all this information is that Medicare pays for cataracts and cancer treatment.

In the $3 million-plus club, 151 ophthalmologists — eye specialists — accounted for nearly $658 million in Medicare payments, leading other disciplines. Cancer doctors rounded out the top four specialty groups, accounting for a combined total of more than $477 million in payments.

So using the rationale that this data will allow consumers better decision-making on choosing physicians, are we shocked that Medicare -  insurance for the elderly - pays out a significant amount of money for cataracts and cancer treatment, both illnesses of the elderly?

Having been both a provider and an administrator in the medical field for close to 15 years, what this information tells me is that doctors are for the most part underpaid by Medicare. If the median amount is $30,000 that any one physician makes in treating Medicare patients and the Medicare population is rising, then it is obvious that the reimbursement rates are lowering. This is exactly what is been happening since the year 2003 with a Medicare fee schedule that, while it does not cut, it does not give raises. As a medical administrator, all this information has done is prove to me that Medicare is not adequately paying for the work performed by physicians.
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