In April, the Centers for Medicare and Medicaid Services released a treasure trove of data detailing how much money it pays the doctors who care for patients in the Medicare Part B program.
Based on that information, ProPublica last week launched Treatment Tracker.
About the tool:
The online tool allows people to compare different doctors on various measures: How many patients they see, how many services they perform, and how much they’re paid by Medicare. You can dig deeper to find out how a specific doctor compares with others in the state and specialty, which providers are in the doctor’s network, and the doctor’s most commonly provided services. The tool lets you search by provider, city or zip code.
ProPublica reporters Charles Ornstein and Ryann Grochowski Jones write that looking at raw numbers, i.e., how much a doctor earned from Medicare, can "unfairly flag some doctors who have multiple providers billing under their IDs or who justifiably use expensive services."
"It can be more revealing to look at which procedures doctors are performing and how frequently, and how their billings compare with those of their peers," they write.
What they found:
Ornstein and Grochowski Jones analyzed which doctors across the nation billed Medicare the most frequently for the most expensive type of office visits in 2012.
By exposing such massive variations in how doctors bill the nation's health program for seniors and the disabled, experts said, ProPublica's analysis shows Medicare could—and should—be doing far more to use its own data to sniff out cost-inflating errors and fraud.
Meanwhile, in California:
KQED, the NPR affiliate in San Francisco, partnered with ProPublica on this investigation. Lisa Aliferis, April Dembosky and Lisa Pickoff-White learned that three California doctors are among the top five nationally in billing for the highest number of the most complex office visits. Also, they write, these doctors tended to bill at the highest level significantly more often than others in their specialty.
Among the three was cardiologist Dr. Jeffrey Mace, of Santa Cruz County. KQED found that nearly every one of his patients received – and was charged for – the highest complexity visit.
So what's the deal with these doctors?
KQED reached out to the three doctors, and only Mace responded. In a written statement to KQED, he defended his billing practices:
I’m not an average cardiologist... I spend a great deal of time taking care of patients. I generally spend 12-16 hours per day in the practice of medicine. I do not take any lunch breaks. I am on call 24 hours a day, seven days a week and do not take vacations. By being available and devoting a great deal of resources to the patients, I hope that this comprehensive care translates to improved quality of life for my patients and hopefully, improved quantity of life (longevity).
Billing for an individual visit is not about a physician’s dedication. Experts say it is about the patient’s complaint that day.
Check out Treatment Tracker, and let us know if you find anything interesting. We’ll certainly be following up on this information as well.