Medicare Payments Concentrated in Few Specialties

Medicare’s 2012 payments to providers were largely concentrated in a few specialties, according to recent disclosures.

An analysis of federal physician billing data illustrates that 14 percent of disbursements went to the top one percent of physicians, with the bulk of payments concentrated in oncology and ophthalmology.

Without information about individual patient cases, though, physicians argue that the raw data lacks the necessary context to be applied effectively. Billing data was off-limits from 1979 until 2013 due to an injunction filed by the AMA for this reason, among others. Many physicians are also concerned that patient and physician privacy could be at risk now that billing data is available.

That oncology and ophthalmology top the list of highest-paid specialties is unsurprising given that Medicare patients aged 65 and older are their primary demographic. Much of the money paid out to ophthalmologists covered many common eye drugs that the physicians purchase up front and prescribe for little profit. On the other hand, last year CMS reduced payments for cataract surgery to reflect updates to the procedure.

Economists hope to use billing data to identify physicians who perform high-revenue procedures with little value to the patient in order to increase their billing. The greatest concern posed by the information as presented is the possibility that some seniors may go through unnecessary treatment simply for a higher paycheck. The AMA cautions that the data released do not illustrate the value of services provided, however.

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