New Medicare data holds doctors accountable

According to data released by the US government, it was found that a small group of doctors were held accountable for a large amount of Medicare payments.

In 2013, according to an analysis conducted by Bloomberg on data from the Centers for Medicare and Medicaid Services, it was found that around 3,900 health care providers were paid by Medicare a sum of $1 million. Overall, the agency stated that data was released on $90 billion in payments for 950,000 organizations and providers. On an average, the reimbursement given to doctors was somewhat close to $74,000 however 5 of them were given an amount of more than $10 million.

Transparency is being increased by the US as the former accounts for a large proportion of the federal spending after the spending on defense and social security. Information was also released by the CMS regarding the $62 billion in terms of Medicare payments which was given to outpatient facilities and hospitals in the year 2013 which reflected more than $7 million in discharges.

Medicare Advantage was not included in the data which was released by CMS which accounted for around 30% of the beneficiaries in the previous year. The drug prescription benefits of Medicare Part D payments in the drug program were also released for the very first time. Some of the payments were made to organization instead of being given to individuals. Around 897,000 active physicians are in the US, which was stated by the Kaiser Family Foundation.

Medicare provides coverage for around 54 million people which include the elderly, some individuals who are disabled as well as those who are suffering from kidney disease and are at the end stages of it. Inpatient and outpatient care make up the most of the payments made as part of the budget of Medicare whereas 16% of spending is accounted for by doctors and this does not include Medicare Advantage.

In 2013, Medicare received a spending of $586 billion by the US which is around 20% of the entire health care spending of the country. Payments made by Medicare to doctors for a long time were kept from the public after it was argued in 1980’s by medical associations that releasing them would cause the privacy of physicians to be violated. In 2013 may, the 33 year old injunction was lifted by a federal judge on the data which followed the lawsuit by Dow Jones & Co. in 2014 then the Obama administration made the decision of making all payment information public.

Last year, some doctors were shown as having received the highest amount of payments and stated that the members in their medical group had been billed using a single provider identifier. Groups of doctors also stated that the data was faulty as it included reimbursements for drugs to doctors and not just payments made for procedures conducted. For e.g. a number of eye doctors were at the highest in the data released in 2012 because the payments they received were covering the cost of treatment for degenerative eye diseases which took place in their own office.


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