Posted On: April 23, 2014 by Patrick A. Malone

Making the Most of Medicare’s Doctor Pay Report

Last week, we introduced readers to the new, searchable federal database (“How Much Did Your Doctor Make From Medicare?”) showing what doctors were paid in 2012 by Medicare. It’s an important new tool showing your tax dollars at work, and how practitioners in your area might be using (and possibly abusing) this important health-care program.

But like every other informational resource, the database is most useful only when you put its data into context; when you understand how different practices and specialties demand different use of medical resources. Naked numbers aren’t very useful.

An insightful commentary by Charles Ornstein in the Los Angeles Times shows why the Medicare pay information is helpful, and why it’s limited. Ornstein is a Pulitzer Prize-winning journalist at ProPublica, the investigative news service that introduced Dollars for Docs, a data base of payments by a dozen pharmaceutical companies to health-care professionals for promotional activities, consulting and research.

Ornstein reminds readers that this autumn, as part of the Affordable Care Act, the federal government will release data on personal, promotional and research payments to doctors from all pharmaceutical and medical device companies, not just the ones represented on Dollars for Docs. “Armed with this information,” he writes, “patients will be able to at least ask whether their doctors have prescribed a drug because it is the best one for their patients — or because of a financial relationship.”

But data can be misleading. “There's a big difference between, say, a hospice doctor giving almost every patient a narcotic and a podiatrist doing the same thing,” Ornstein points out. There’s a big difference between doctors who treat the urban poor, who tend to be sicker when they seek treatment, and those who treat affluent folks with sufficient health insurance.

To get the most out of the Medicare information, you must know what is available, what's missing and how to interpret it. Raw numbers, Ornstein reminds, don’t tell you “whether one doctor's patients are sicker than another's and need different therapies. They won't tell you about a doctor's bedside manner or willingness to return a phone call at 3 a.m. They won't tell you about a doctor's surgical skill.”

Another story in the Los Angeles Times mentioned that one doctor, according to the Medicare information, received millions in Medicare payments that seemed off the charts in comparison to his peers. But it turned out that all eight of the doctors in his practice billed Medicare under his name, so it looked as though a single practitioner received payments that, in fact, went to eight people.

So Medicare’s database is a place to start, but for context, don’t overlook other avenues of information, such as review sites including Healthgrades and Yelp, where consumers offer opinions of their doctors — but be aware that your priority for a practitioner might not be the same as some other patient's.

Research practitioners on state medical board websites to see if someone has faced disciplinary action. (See our blog, “How to Find Out If Your Doctor Has Been in Trouble.”)

If you’re really ambitious, you can research lawsuits to unearth malpractice and other medical-legal histories.

It’s all an effort to help you get the best care for your needs. As Ornstein summarizes, “Access to information is crucial if patients are to have any hope of answering that most basic of questions: How does my doctor practice medicine?”

“We're still a ways off from having enough information to do an overall comparison of the quality of care from one physician to another,” he writes. “But Medicare should be applauded for its new release of data, and it should continue to do more. It should also encourage private insurers and other public programs to follow suit.”

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