By Meghan Hoyer, Laura Ungar and Jayne O’Donnell
June 2, 2015
Medicare providers got more for mental health and specialty care including sports and sleep medicine in 2013, according to new payment data released Monday that shows which healthcare providers received the most money.
A USA TODAY analysis also found Medicare payments in more traditional areas of medicine -- including cardiology, general practice and geriatric medicine -- were all down.
In total, more than 950,000 health care providers collectively received about $89 billion in Medicare payments in 2013, according to the Centers for Medicare and Medicaid Services.
This includes $17 billion for drugs administered and $72 billion for medical services. In 2012, total spending was nearly $90 billion, but with 25,000 fewer providers.
Among the biggest changes:
- Spending on psychiatry was up 9.3%, to $853 million;
- Sports medicine increased 56%, to $32 million;
- Sleep medicine soared, as 100 new practitioners in the specialty received $7.2 million;
- General practice was down 7.6% to $380 million.
CMS released the data for the second year on medical services doctors provided and how much they were paid through Medicare, the government health insurance program for the elderly and disabled.
The data examines Medicare "Part B," reflecting the fees for services paid to doctors treating roughly 34 million people. It does not include billing under the Medicare Advantage program.
"This is extremely valuable information for policymakers and purchasers so we begin to understand the cost of healthcare to the American taxpayer," says Leah Binder, CEO of the Leapfrog Group, which promotes price transparency and safety. "We are only now beginning to see trend data. For most of our lifetimes we were forbidden from seeing this data, so finally we are moving in the right direction."
The doctor who received the most from Medicare was Anne Greist, who co-founded the Indiana Hemophilia & Thrombrosis Center in 1998. Greist received more than $28 million, but $27.9 million of it was simply passed through her to pharmaceutical companies for expensive drugs.
Greist is also co-medical director and adult hematologist at the center, which is at the St. Vincent Hospital campus in Indianapolis. It is Indiana's only hemophilia center.
"There are other physicians who see these patients but Dr. Greist Is the lead patient care coordinator and, as such, is the more frequent prescriber," says Nancy Hoard, the center's executive director.
The second-ranked doctor is facing legal troubles. In January, the Justice Department joined whistleblower lawsuits that alleged physician Asad Qamar of Ocala, Fla., and his Institute for Cardiovascular Excellence performed excessive and unnecessary procedures on Medicare patients. He received more than $16 million in 2013, but only a very small amount for drugs.
One of the lawsuits alleges Qamar got patients to undergo the procedures by waiving the 20% Medicare co-payment, with no regard for the patients' financial need.
Qamar did not respond to a call seeking comment, but did address the allegations in a video he posted on YouTube, calling them "fiction."
Third on the list was Salomon Melgen of West Palm Beach, Fla., an ophthalmologist who received $14.4 million, including $7.7 million for medical services, according to the CMS data.
In April, federal prosecutors charged Melgen, along with Democratic Sen. Robert Menendez, with participating in a long-running bribery scheme. Menendez was charged with using his office to benefit Melgen in exchange for nearly $1 million in gifts and campaign contributions, according to prosecutors.
From 2006 to 2013, court documents said, Melgen lavished gifts on Menendez and he "used the power of his Senate office to influence the outcome of ongoing contractual and Medicare billing disputes worth tens of millions of dollars," court records show.
On Monday, a woman in Melgen's Florida office said no one would be able to comment on his behalf by deadline.
The fourth-highest-paid doctor on the list was Alexander Eaton, another ophthalmologist from Florida, who received a total of $12.1 million in Medicare payments in 2013, $3.5 million for medical services. Eaton could not be reached for comment Monday.
In fact, ophthalmologists comprised 10 of the top 20 highest-paid doctors under Medicare. Michael Repka, medical director of governmental affairs for the American Academy of Ophthalmology, attributed that partly to the specialty's large portion of older patients and partly to the expensive drugs used to treat age-related macular degeneration, a leading cause of blindness.
The American Medical Association, doctors' powerful trade group, is "committed to transparency that improves patient care and ensures patients and physicians have access to the data they need to make informed medical decisions...," according to a statement by AMA president Robert Wah.
Even though CMS improved the data since last year by separating Part B drugs from physician service payments, the latest data "still has significant shortcomings," Wah said.
"Specifically, the data released today does not provide actionable information on the quality of care that patients and physicians can use to make any meaningful conclusions," he said in his statement. "It also does not provide enough context to prevent the types of inaccuracies, misinterpretations and false assertions that occurred the last time the administration released Medicare Part B claims data."
The data includes the number of services each doctor provided, the doctor's average charge, the average Medicare payment and the sum of the Medicare payment and any deductible or co-insurance the patient owed, called the 'Medicare allowed amount.'
Some specialties — such as hematology and oncology — have high overall average costs per doctor, but when the drugs are taken out of the equation, the average costs are much lower.