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CMS Data On Medicare Payments to Doctors

The Center for Medicare and Medicaid Services (CMS), also known as Medicare, published data this week that publicly shows how much it paid to individual doctors during 2012.  Here's a link to a NY Times interactive tool that allows you to look up payments by doctor and zip code.  The tool shows total payments and frequency of billing.

What are the pros and cons of this data?  First and foremost, services provided by Medicare contracted providers are reimbursed with federal funds.  That means that your tax dollars and my tax dollars are paying for these services.  Therefore, payment summaries ought to be public information, accessible to you and me.

So like every good doctor I started to snoop and what I found was really quite amazing.  My community has two large independent family practice groups.  When I went to compare reimbursement for each of the doctors in those groups I found two trends.  Let's take a closer look.  Practice A is a four doctor group.  On the low end of reimbursement for providers at practice A, one doctor received $49,000 and a high reimbursement for another doctor of $108,000.  The mean CMS reimbursement for providers at practice A was $65,000.  Now let's take a look at the other practice that we'll call practice B.  Practice B is a 4 doctor group with a low end of reimbursement of $154,000 and a high of $431,000.  Mean for this group was $281,000.

Is anyone scratching their head yet?  How could two similar practices, in the same community have a difference in their mean payments from Medicare be so high?  The difference between the mean reimbursement for the two practices was $216,000.

But if we move away from the concept of how much we're paying each provider and look a bit more closely at what we're paying each provider for, the data becomes a bit more interesting.  A brief survey of my profession reveals some interesting data regarding the volume of services provided by each individual provider.  It's interesting to look at discrepancies between practices.  And I find it amazing how one practice would have so many of one type of procedure while another seems to rarely provide the same service.

For CMS to make payments to individual doctors public, is brilliant.  For the first time, patients can compare providers based upon their volume of services and types of services provided.  It's an opportunity for us as health care consumers to put a finger on the pulse of a practice.  Although the information provided to us by CMS may not be a direct reflection of the practice, it certainly does allow us, for the first time, to look behind the closed doors of healthcare.

How does this new information change health care?  The changes don't start here.  Changes begin with the conversation about care.  And now that we are able to take a peek at objective data that details the types and volume of services provided inside these practices, let's start talking.


Dr. Jeffrey Oster

Jeffrey A. Oster, DPM
Medical Advisor

Updated 12/27/19

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