Local health care providers receiving top Medicare payments in 2012 examined

April 14--The 10 Bloomington-based medical providers receiving the most money from Medicare in 2012 are from several different fields.

They include cancer specialists, a surgical center, a dermatologist, ophthalmologists, an internal medicine doctor and an infectious disease expert. But seven of the 10 are affiliated with one of two medical organizations: Premier Healthcare and the Eye Center of Southern Indiana.

The doctor receiving the most from Medicare is Mark Dayton, a hematologist/oncologist with Premier Healthcare, according to new data released by the federal government last week. Other Premier doctors on the top 10 list were hematologist/oncologists Karuna Koneru and Jacqueline Joyce, as well as internist Tom Hrisomalos, who is an expert in infectious diseases.

Dayton was significantly ahead of other providers in Bloomington in Medicare payments received. His payments received totaled more than $2.7 million.

After Dayton, the next-highest Bloomington-area payment recipient was Integ Health System P.C. at $1.5 million. Integ Health System is surgical center registered with the federal government under Dr. Rex Daniel Grossman.

Grossman is an ophthalmologist who founded the Eye Center of Southern Indiana. He also appears on the list of top 10 Bloomington Medicare recipients, ranking ninth. One other ophthalmologist affiliated with the Eye Center of Southern Indiana is on the list as well, Dr. Warren Chang.

There are a number of reasons a physician could appear among the top Medicare payment recipients. Dr. William Schmalz, an internist who received the eighth-most money from Medicare among providers in Bloomington, said he's practiced medicine for nearly 40 years. It's possible he treats more Medicare-age patients than other doctors.

"I take care of individuals on a continuing basis," he said. "In many cases, these are people I've taken care of for 39 years. They've matured to Medicare age."

Schmalz also pointed out that Medicare payments aren't profit for physicians. They have to go toward treatment costs, rent, payroll costs for office employees and malpractice insurance.

Medicare is not the only source of income for physicians. There's also private insurance and Medicaid, which covers those with low incomes. But Medicare is a big chunk of health care spending in the country.

Medicare reimbursement rates have been going down for physicians, Schmalz said.

"I far more commonly hear from my colleagues that you don't want or will not take Medicare patients," he said. "The actual margins that we have are so slim, by the time you pay your overhead out of those expenses, it can be a money-losing proposition for some people."

About eight years ago, Schmalz calculated how long it took his practice to earn enough to pay off its overhead and expenses. It took 10 months, he said.

"When I woke up on Jan. 1, it was literally after Halloween before I ever put a penny or a dollar in my pocket," he said.

Another physician on the list of top 10 Bloomington providers receiving Medicare payments was Dr. Teresa Oldham, who specializes in treating prostate cancer at the Indiana University Health Proton Therapy Center.

The center's chief operating officer and chief financial officer, John Kerstiens, said he was surprised in some ways to hear Oldham was on the top 10 list, but not surprised in others.

Since she treats prostate cancer, her patients would often be old enough to be billed through Medicare, he said. Oldham treated 40 men with prostate cancer in 2012, and 23 of them had Medicare as their primary insurer.

But the proton therapy center bills through a Medicare contractor that has the lowest reimbursement rates for proton therapy in the country, Kerstiens added. He also noted that reimbursements for proton therapy are thought to be higher than those for other treatments.

"I really think we're going to find the reason she's on the list is she treats so many patients from outside the region," he said. "Prostate cancer, although it's fairly prevalent, the demographics for Bloomington would not suggest she should be that high."

Only 17 of Oldham's patients were from Indiana. Just 2 were from Monroe County.

The other physicians on the top 10 list did not respond to requests for comment left by telephone at their offices.

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