Viewpoint

What were they thinking?

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

Every so often our government does something so outrageous that we are left scratching our heads asking, “What were they thinking?” or something perhaps a bit less charitable. One such occasion just happened when the powers that be, in all their consummate wisdom, publicly released government payments to individual physicians.

Why would they do this? HHS Secretary Kathleen Sebelius said, “Currently, consumers have limited information about how physicians and other health-care professionals practice medicine.” Ms. Sebelius added, “This data will help fill that gap by offering insight into the Medicare portion of a physician’s practice.” Meanwhile, CMS Administrator Marilyn Tavenner said, “…this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program.”

How exactly does releasing how much I receive from Medicare give insights into my practice? How does it help better understand how care is delivered?

I have no answers. And the really bad news were widespread reports that the greatest beneficiaries of Medicare’s largesse were ophthalmologists, including the winner receiving more than $20 million. Half of the 100 highest-paid physicians were ophthalmologists, despite the 2013 Medscape Compensation Report that ranks us 11th in specialty compensation.

The Academy, ASCRS and ASRS have all stepped up with good position papers worth reading. I’d summarize why we receive so much more from Medicare than many others specialists thusly:

• Our patients are old. My own pathology-focused practice is 90% Medicare.

• Old people get way more diseases than young people. Cataract, glaucoma, AMD (hint: We even call it “age-related”), diabetic retinopathy and even dry eyes are mainstays of the general ophthalmologist.

• Our overhead is among the highest in medicine. If your overhead is 75%, that $1 million payment from Medicare translates into a $250,000 net (before taxes).

And then the biggie: The CMS data included payments for Part B drugs. Are you kidding me? If you gave 20 Lucentis injections four days a week, 48 weeks a year (a feat that wouldn’t be a stretch in some busy practices), that alone is more than $7 million, the overwhelming amount of which simply passes through to the drug manufacturer. One of my friends is a retina specialist, and when he analyzed the data, the top seven paid doctors in his city were all from his retina group!

The list of other objections is lengthy. Kudos to the AMA who fought for years against the release of this data, arguing it wouldn’t be interpreted in the proper context. (For a more in-depth look, see our cover article on page 26.) As Ronald Reagan said, “The nine most terrifying words in the English language are: ‘I’m from the government and I’m here to help.’” OM