Specialists the top recipients of Medicare money

Federal health officials released a huge database last week of Medicare payments to individual health-care providers, including $163 million paid in Montana in 2012 to nearly 3,300 providers.

Nationwide, the database showed that just 2 percent of the 880,000 doctors and other providers received one-fifth of the total $77 billion paid out in 2012.

In Montana, the concentration among the top recipients was even greater: The top 2 percent, or 65 providers, took in $45.3 million in Medicare payments in 2012, or one-fourth of the total.

The database showed the largest aggregate payments often went to ophthalmologists, dermatologists and cancer specialists — although the largest single recipient of Medicare payments in Montana was a Billings rheumatologist at $3.6 million.

Rheumatologists treat arthritis and other diseases of the joints and bones. The second-highest was a Billings ophthalmologist, with $1.8 million in payments.

The top Medicare recipients in the Flathead Valley were two Kalispell ophthalmologists who took in $738,000 and $706,000, respectively, enough to place them in the top 20 Montana physicians who took Medicare funds.

Ophthalmologists are eye and eye-surgery specialists. 

No other Flathead provider topped $500,000 in Medicare payments, although two Kalispell dermatologists took in more than $300,000 each.

Mike Fierberg, a spokesman in Denver for the federal Centers for Medicare and Medicaid Services, said while the records show some providers received extraordinarily high amounts, they didn’t necessarily get all of that money.

The portion of Medicare that covers doctor visits and non-hospital care also covers prescription drugs administered by some specialists, such as cancer and eye specialists, so the payments may include money spent on those drugs, he said.

Fierberg said those payments generally don’t go to the doctor, but to the drug company.

The Obama administration said the database is part of its effort to make the nation’s health-care system more “transparent, affordable and accountable.”

When asked whether the data would be investigated for possible misuse of Medicare, Fierberg said that’s up to the HHS inspector general.

Medicare payments to individual doctors have long been held secret, but a federal judge ruled last year that the information can be made public.

Medicare, the government insurance program primarily for those 65 and older, covers hospital services and care provided by physicians and other providers, such as nurse practitioners, physical therapists, physician assistants and ambulances. Hospital services are covered by “Part A” and the other services by “Part B.”

Wednesday’s data are for payments under Part B to individual providers. It doesn’t include money paid to hospitals or employees of hospitals, such as doctors, unless they used their own, individual “national provider information” number when they billed Medicare.

Medicare also doesn’t necessarily cover the entire cost of a service. The data are for the payments that went directly from Medicare to the provider, and don’t include payments from the patient or other insurers.

Other highlights of the Montana data:

-- Eight providers took in more than $1 million in Medicare payments in 2012, including a Billings ambulance service and a Missoula eye surgery center. Thirty-four providers topped $500,000 each.

-- Forty-eight ophthalmologists, who are eye and eye surgery specialists, averaged $340,000 each in Medicare payments. Two of them topped $1 million in payments and another eight topped $500,000. Also, 29 dermatologists averaged $224,000 each in Medicare payments, with the highest taking in $737,000 on almost 8,400 procedures.

-- On the lower end of the scale, family practice doctors averaged about $30,000 in Medicare payments.

-- Billings, the state’s largest city and a big medical center, had almost $44 million of the reported payments, or 27 percent of the total. Missoula, the only other Montana city with two hospitals, had $33.8 million, or 21 percent. Great Falls was third at $21.7 million, or 13 percent.

Overall, about 2 percent of clinicians accounted for one-fourth of payments.

Reporter Ryan Murray of the Daily Inter Lake contributed to this story.

Distributed by MCT Information Services