Georgia doctors: Medicare payments don’t tell whole story

Two of Atlanta’s top eye specialists found themselves Wednesday on a list of Georgia doctors who received more than $1 million in payments from Medicare in 2012, as did several of the state’s cancer doctors and pain management specialists.

The doctors quickly pointed out that the long-awaited release of $77 billion worth of Medicare payment records didn’t tell the whole story, though.

Dr. Robert Halpern, an ophthalmologist, said $3 million he was paid for treating Medicare patients was driven largely by the cost of $2,000 injections that are administered repeatedly to stave off blindness among patients with macular degeneration. Halpern said he gets paid about $100 for giving the injection and makes virtually no profit on the medication itself.

“The concept of transparency is great — we need more of that in medicine,” Halpern said.

But he and most physician organizations said this gigantic information release could be misleading if patients think doctors are taking home all the money Medicare reported paying them, when much of it goes to the costly medications or services they use to treat their patients.

The release of the records was Medicare’s latest attempt to provide consumers with more information about the nation’s health care system, down to the nitty-gritty of what Medicare paid everybody’s personal physician. The new data set has information on exactly how much it paid 880,000 doctors and other health care providers across the country in 2012.

The data is designed to help consumers and researchers understand how practice patterns might vary from one doctor’s office to another — or from one city to another. Researchers might explore whether doctors in Atlanta tend to use more expensive medications than doctors elsewhere. While Medicare has mined the data for years to deduct fraud and abuse, making it public could also help to flag doctors who are overtreating patients or bilking the system. Patients might want to make sure the doctor who will be doing their joint replacement has actually done lots of the procedures in the past.

“It’s part of an overall effort just to provide all parties in the health care system more transparency about Medicare specifically and health care in general,” said Bill Custer, a health care expert at Georgia State University. “This data isn’t very useful by itself, but it could be tremendously useful when combined with other sources of information.”

The Atlanta Journal-Constitution analyzed the information on Wednesday to see how Georgia’s physicians stacked up in the Medicare billing game. The AJC found that Medicare paid about 100 Georgia physicians over $1 million in 2012. Three Georgia doctors were paid more than $3 million, putting them in an elite group of just 344 doctors nationwide.

Landing at the top of the Medicare reimbursement was a surprise — and even a shock — to some Georgia doctors.

Dr. Oscar Stokes, a pain management specialist in Roswell, was astonished to hear that the data showed him receiving more from Medicare in 2012 than any other Georgia physician, with $5.8 million in payments. Stokes was also listed among the top Medicare billers nationally, the AJC found.

Stokes said he worked as an employee of a pain management doctor in Alabama in 2012, and that the billing was handled by the practice. He said he had an inkling that some of the billing practices were under scrutiny when he was contacted by Medicare investigators who told him about claims tied to his name.

“They called me and told me the dollar amount and I was in shock,” he said.

Stokes said he was paid only a tiny fraction of what was billed under his name, much of it for pain medications. He said he left the Alabama office to open his practice in Roswell, where he can closely monitor the billing. “I am doing things the right way,” he said.

Patrick Robbins, the administrator of the Alabama practice where Stokes had been employed, said Wednesday that billing at the practice had been subjected to a Medicare audit. But he said that the vast majority of claims had been approved as appropriate and that a high dollar-figure associated with reimbursements doesn’t necessarily indicate a problem.

“We have followed Medicare guidance,” Robbins said. “We have been proven to be in almost 100 percent compliance with that guidance.”

Medicare reported paying Dr. Mark Ellis, an Athens pain management specialist, $3.4 million in 2012. Ellis ranked second statewide, the AJC found.

Ellis said he operates several pain management clinics around Athens and he didn’t dispute the numbers. But Ellis, like some other doctors, said the information may be misleading because services provided by physician assistants in his office are billed under his name.

“The numbers can be confusing and can be misinterpreted,” said Ellis, who added that he appreciated the opportunity to put the numbers in context.

“The overall number we’re not going to dispute,” he said. “We worked hard and are entitled to being reimbursed as such.”

A New York Times analysis of the entire database found that Medicare paid 100 doctors a total of $610 million, including a Florida ophthalmologist who was paid $21 million. The Times analysis found that the same types of specialists common among high Medicare billers in Georgia — eye and cancer specialists — also dominated the top of the list for the nation.

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