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A Doctor Takes A Look In The Medicare Mirror

Sunday, June 08, 2014

After decades of fighting to keep how much Medicare pays individual doctors a secret, the federal government bowed to pressure from journalists and consumer groups and released the information in April.

The data let reporters โ€” and anyone else โ€” figure out who is getting paid by Medicare for what.

A few docs at the top of the Medicare pay pyramid made headlines. Some pathology groups, which analyze blood and tissue samples, bill Medicare for all of their tests under one physician's name. Other top billers were ophthalmologists who use expensive drugs in their offices that are reimbursed by Medicare as a practice expense.

As a teacher and a practicing physician, I was curious to learn what I could about my own Medicare billing from the public data. So I plugged my name into both The New York Times' Medicare database tool and ProPublica's Medicare Treatment Tracker to see where I stood.

What did I find? In 2012, Medicare reimbursed the university where I work $45,994 for my services. Not much compared with the $21 million paid to a Florida eye doctor who specializes in treating macular degeneration. No doubt he's looked at a lot of eyeballs. A lot of eyeballs!

The most common charge I submitted was for what's called a level 3 office visit. This happens when I know the patient, the medical problems are relatively stable, and the medical decisions are pretty straightforward. This category also applies to many of the visits between residents and patients that I supervise.

My next two most common charges are interesting, in that they're evenly divided between office patients and patients in the hospital. A split like that is becoming a rarity. Most internists now choose to practice exclusively in hospitals or in offices or clinics.

Teaching hospitals and rural areas are the most common places where this still occurs.

I was reimbursed a little more than $8,000 for the care of complex patients in the hospital. But I have to point out that the bills are different depending on whether they're submitted on the day of admission, a subsequent day or on the day of discharge. Easy, right? Medicare also paid about $7,500 for me to see patients with more complex problems, so-called level 4, in my office.

The charges roll on downhill from there, in terms of hospital admissions, discharges and less complicated office visits.

If you want to make sense of all these newly released Medicare charge data for your doctor, it helps to know a little something about his or her practice. In my case, I'm an academic doctor with a job divided roughly into thirds: one part patient care, one part teaching and the remainder devoted to administrative work. So my Medicare charges are much lower than the average doctor who spends nearly all of the workweek engaged in patient care.

There were a couple of things that I learned from looking at my Medicare data. I was able to bring in a small amount of money (about $5 a pop) by offering some patients an easier blood test in our nurse-led anticoagulation clinic. Patients who have to take blood thinners are monitored closely so they don't clot or bleed. The test requires only a finger stick and gives near-instant results compared with the old blood-tube-from-the-elbow-type test. It also keeps the Medicare dollars, small though they are, from the lab, which is administered separately.

I also was reimbursed for reauthorizing plans of care at home. You may have read that doctors complain about too much paperwork nowadays. Home health forms are but one example, which involve overseeing and documenting a plan of care for an elderly or disabled patient at home. I was pleasantly surprised to learn that this service actually brings in some money (on average about $30 each time I do it). Who says busywork doesn't pay?

Lastly, I brought in more than $700 in Medicare fees just for ordering flu shots, which, of course, are actually given to patients by our nurses. It's well worth the $20 or so Medicare pays per shot to have them administer flu vaccine. They're total pros.

John Henning Schumann is a primary care doctor in Tulsa, Okla., where he teaches at the University of Oklahoma School of Community Medicine. He also hosts Public Radio Tulsa's Medical Matters. He's on Twitter: @GlassHospital

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Source: NPR

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