The Spectacle Blog

A Monumental Step in Medicare Transparency

By on 4.9.14 | 3:33PM

In a monumental transparency effort, the Center for Medicaid and Medicare Studies has released Medicare payment data covering $77 billion given to 880,000 practitioners in 2012.

For the first time in 35 years, the public can see how and where their Medicare tax dollars are being spent. The American Medical Association has fought this release for years, fearing that people would jump to misinformed assumptions about the data.

According to Bloomberg, Medicare paid nearly 4,000 physicians $1 million or more each in 2012:

The listing, gleaned from 880,000 providers paid by Medicare, was released this morning. The data, the first look at physician payments by the agency in more than 30 years, showed that most spending fell to a small group of doctors, with less than 3 percent taking in about 28 percent of the $64 billion paid out to individual providers.

Because of the AMA’s opposition to the data release, the measure has received mixed feedback. Jonathan Blum, the principal deputy administrator for the CMS, said that he knows fraud in the system exists and the point of releasing the data was so citizens and journalists would discover said misuse of taxpayer money.

One of the biggest concerns from the AMA is that individuals will see big dollar amounts and automatically assume fraud is involved. In some cases, however, the payments go to cover doctors who have a high number of Medicare patients, highly specialized or efficient practices, or hefty overhead fees. In other words, seeing that a doctor received $21 million from the government doesn’t automatically mean that doctor pocketed all the money or got it fraudulently. Up to three fourths could have gone to cover expenses.

Blood work and radiation cancer doctors and ophthalmologists received the most money from Medicare. Reports say their overhead costs for certain drugs and procedures are extremely high, meaning most of the money doesn’t stay in the doctor’s wallet.

Even still, it’s wise to take advantage of the chance to see how our money gets spent. If an official from the CMS says he knows there is fraud, that’s a good sign that despite all the legitimate expenditures buried in the massive data pile, there are also misappropriations of funds wasting our hard-earned cash.

There are concerns that some doctors over-prescribe certain drugs or procedures because it generates profit. Using a more expensive drug means more taxpayer dollars go the doctor. Not only is this fraudulent, it can hurt patients who don’t actually need certain medicine or surgeries.

In the end, this marks a monumental step for transparency. When Medicare consumes 14 percent of our annual budget, we should know how that $498 billion gets spent. We can expect many more stories and revelations to come from this data which will help Americans better understand the health care sector.

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