Medicare physician data highlights primary care, subspecialty disparities

Medicare’s release of thousands of physician pay records could expose fee-for-service models that reimburse subspecialists at a higher rate than primary care physicians (PCPs).

“There is lower pay for primary care physicians because they deal with the complexity of issues,” says Reid Blackwelder, MD, FAAFP, president of the American Academy of Family Physicians. “There’s a real opportunity to transfer our system to pay for value versus the current fee-for-service model.”

The Centers for Medicare and Medicaid Systems (CMS) released payment information for 880,000 physicians in an effort to be more transparent with the public.

PCPs, including internists, family, and general practitioners, represented almost 20% of physicians paid by Medicare in 2012, and about 20% of the $77 billion paid to physicians that year. Cardiologists, dermatologists, and urologists combined represented nearly 5% of physicians paid by Medicare, and earned 11% of payments. On average, internists received $95,466, and cardiologists received $223,248 from Medicare in 2012.

Containing more than 2 million lines of data, this is one of its largest data releases in CMS’ 30-year history. CMS officials say that the agency wants to encourage the media and other watchdog organizations to identify patterns and outliers in the healthcare system.

“We know there is waste and fraud in the system, and we want the public’s help in identifying spending that seems wasteful,” says Jonathan Blum, CMS spokesperson.

Media reports have already identified outliers who received millions of dollars from Medicare in 2012, including one Florida ophthalmologist who received more than $20 million. According to the New York Times, 2% of physicians accounted for $15 billion in Medicare payments.

The reports raised concerns among several physician advocate organizations that  data released without context may send the wrong message to the public.

“MGMA (the Medical Group Management Association) is troubled about the potential for unintended consequences as a result of the release of this type of data and the effect it may have on Medicare beneficiaries. This release could result in patients making decisions about their care based on faulty assumptions about physicians,” says Susan Turney, MD, MS, FACP, FACMPE, president and chief executive officer of MGMA. “Claims data are not a proxy for quality, especially when provided in isolation, from a single payer.”

Next: Physician privacy concerns

The American Medical Association (AMA) released a statement advising reporters to verify claims data before using it in stories. In previous months, AMA officials have spoken out against the data being released without an explanation of patient outcomes.

“Medicare claims data is complex and can be confusing and the manner in which CMS is broadly releasing physician claims data, without context, can lead to inaccuracies, misinterpretations and false conclusions,” the AMA said in the statement.

Turney says she is also concerned that although the information released protects patients’ privacy, there was little concern about the privacy of physicians.

“MGMA is also concerned about the impact on physician privacy, as releasing physician’s personal financial data and National Provider Identifier information could make providers susceptible to fraud. Physicians should have had the opportunity to review the data before it was made publicly available in order to modify or appeal any inaccuracies,” Turney says.