Medicare spends nearly $2 billion in South Florida
By Daniel Chang, The Miami Herald | |
McClatchy-Tribune Information Services |
The data, unveiled for the first time in
Among the early findings:
After routine office visits, and certain hospital and institutional care, such as nursing facility evaluations, the procedures that
Although some consumer advocates hailed the data release as a step toward greater transparency in healthcare, there also were a lot of cautions from medical groups about how to interpret the information.
The
"We have specific concerns about just reading things into raw data without the appropriate background information as to why the numbers are what they are," Scott said.
Checking data
Analysts are still parsing the data, looking at payment trends, service volumes and provider caseloads. Consumers groups could use the data to identify physicians, their patient volumes and most common procedures.
In
Nearly half of the payments in
In
In total for 2012,
By comparison,
But the geographic variation in
A physician's location can affect the mix of patients that provider sees -- and the treatment options that doctor chooses, said
Doctors in low-income neighborhoods, he said, might draw more local patients who do not have easy access to transportation, while doctors in affluent neighborhoods might draw from a wider geographic area.
Different care
The type of care a doctor provides also might vary by regional medical "culture," Ullmann said, noting that treatment options "tend to be geographically specific."
For instance, he said, cardiologists in one region might provide medicated stents -- tubes inserted to open arteries -- to their patients more often than regular stents, which cost less and receive a lower reimbursement or payment from
"You'll have a culture within an area where you're going to do the more expensive process," Ullmann said.
Under the fee-for-service system used by Medicare Part B, physicians and providers have an incentive to deliver more and costlier care because they are paid for each service, not for quality or outcomes. Those factors might help to explain why certain physicians appear as outliers in the
For example, the amount that
His prolific use of that drug is at the center of the U.S. attorney's criminal investigation into Melgen's thriving practice, which is based largely on payments from the
Healthcare policy experts agree that payment data alone can appear misleading, since it reflects not just the provider's service fees but also overhead costs.
Specialists such as ophthalmologists or oncologists typically use expensive drugs to treat patients, so the amounts paid by
"Oncologists have to pay quite a bit for their oncology drugs, and only get 6 percent on top of the costs," he said in an email. "So their billing would tend to appear to be large -- it's revenue, not salary!"
Another important warning about the data: It does not include privately insured and uninsured patients. Nor does it list patient co-payments, or the amounts that
No easy task
While federal officials urged patients, physicians and others who review the
"Doctors like to compare themselves with others, and if my mortality rate and my use of a particular procedure is much higher than many of my peers, some of them may look at it and say, 'That's the way I'm making money,' " he said. "But some of them will look at it and say, 'Is that the best way for me to practice? Am I doing the best by my patients?' "
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