Medicare by the Numbers
Policy + Politics

Medicare by the Numbers


For the first time ever, the public finally caught a glimpse of how the massive Medicare program pays its doctors.

The Centers for Medicare and Medicaid Services released a massive database on Wednesday revealing how Medicare doled out $77 billion to some 880,000 providers in 2012. 

Related: Historic Medicare Data Dump Blows the Lid Off Doc Pay

The data shows that just a sliver of providers--about 2 percent earned roughly a quarter the overall fees. Some of the top earners --—including an ophthalmologist in Florida—received more than 100 times the average payout in their respective fields. These government figures are for Medicare Part B claims, which includes doctor visits, lab tests and out-patient treatment; they don’t cover commercial insurance, Medicaid or even Medicare Advantage plans.

Consumers and media outlets have pressured Medicare to release the data for years. During a press call with reporters on Wednesday CMS officials said the new information would provide more transparency for Medicare patients.

“For too long, the only information on physicians readily available to consumers was physician name, address and phone number,” CMS officials said in a statement. “This data will, for the first time, provide a better picture of how physicians practice in the Medicare program.”

The release received pushback from the American Medical Association, which cautioned that simply publishing the raw data could lead to a misunderstanding of how much doctors are actually making. That’s because many of the high payments also reflect the steep costs of pharmaceuticals and medical devices.

Related: Two New Studies Raise Red Flags on Obamacare

“We believe that the broad data dump today by CMS has significant short-comings regarding the accuracy and value of the medical services rendered by physicians. Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences,” the group said in a statement.

In some cases, the payments listed under one provider’s name actually represents what his or her entire staff is receiving from Medicare. For example, Newport Beach oncologist Minh Nguyen was listed as Medicare’s highest paid doctor in California—getting about $11.3 million for treating Medicare patients in 2012. However, Nguyen told the Los Angeles Times that was misleading since all five physicians at his oncology practice bill Medicare under his name. He added that much of that money is also used for expensive chemotherapy drugs.   

"Without an explanation, it looks like doctors are making a gazillion dollars," Nguyen told the LA Times. "Holy smoke, if I made $11 million I would have a private jet. It's ridiculous the government can release these numbers and make me look like a bad guy. I make a good living, but I'm not making seven figures."

Health experts maintain that the information is important in order to give patients insight into their medical costs, but warn that it needs to be viewed with proper caution and context.

Here’s an overview of the numbers in this week’s historic data drop:

$500 Billion What Medicare spends every year.

$77 billion – the amount providers received from Medicare in 2012.

$26 million- The highest amount Medicare paid one provider--an ophthalmologist in West Palm Beach, Fla. (That’s nearly 61 times more than what Medicare paid the average ophthalmologist.)

$23 Million- The amount Medicare paid a cardiologist in Florida—about 80 times the average payment for that specialty.

$17 million The amount Medicare paid to doctors who have been charged with Medicare fraud over the last 16 months, according to The Hill.

$4 million The minimal amount 100 of the 825,000 individual physicians each received in 2012, according to The New York Times. 

$1 million the average amount Medicare paid clinical laboratory workers in 2012.

13 percent- The percentage of total Medicare payments that went to oncologists and ophthalmologists—two specialists that billed the program the most.

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