Remember when the Center for Medicare Services (CMS) released physician payment data last month? The move caused quite a stir and was largely unpopular among physician groups. Not only does the database include stats on Medicare payments to physicians, numbers for nurse practitioners are listed in the data set as well. What do you as an NP need to know about this latest effort at healthcare transparency?
Last month, after a court order lifted an injunction in place since 1979, CMS released information regarding 2012 reimbursement rates to medical providers. The information includes the name, address and specialty for each provider as well as a list of CPT codes performed by the provider for more than 10 patients annually. The average charge for each CPT code and average reimbursement rate are also listed. CMS’s resource contains only information for traditional Medicare patients, not those with Medicare Advantage plans or who are privately insured. So, if you don’t treat many seniors your name may not be included on this list of over 800,000 medical providers.
With the release of this information, a media frenzy ensued calling attention to top paid physicians who bill Medicare millions of dollars each year. The hype is exactly what doctor’s organizations feared. Physicians say that Medicare’s information can be misleading. When a provider submits a claim to Medicare much of that amount accounts for aspects of care other than the doc’s take home pay. For example, the cost of a clinic visit or hospitalization includes practice overhead as well as the cost of medical devices or medications administered to the patient. Additionally, in some practices, claims for multiple providers are submitted under the name of one physician skewing numbers. Physicians argue that CMS’s data can be easily misconstrued and potentially mislead patients.
Advocates of healthcare transparency applaud this latest move by CMS saying it’s time patients have more information about their medical providers. For example, by looking at how many and how often certain providers perform procedures, patients can make educated decisions about which provider will best meet their needs. Advocates argue that airing data openly encourages providers to curb medical spending and use resources responsibly exposing providers in violation of these principles.
As always, I was interested to see if nurse practitioners made the cut in the release of Medicare data. I expected that since my practice typically submits my claims under the name of a physician, I would not make the list. But, I was wrong.
First, I attempted to search for my Medicare payment stats using CMS’s “Provider Utilization and Payment Tool” which proved cumbersome and frustrating to use. Not surprising. Fortunately, I found the New York Times “How Much Medicare Pays for Your Doctor’s Care” search tool was much more user-friendly. To my surprise, my name was listed next to “$16,129 total reimbursed by Medicare in 2012”. Here are my stats:
Reviewing my numbers, I couldn’t help but notice the discrepancy between how much I bill Medicare and how much I am reimbursed for these claims. A $35 claim for reading an EKG nets just a $5 payout.
While many medical providers are apprehensive about the release of Medicare billing and reimbursement data, looking at my own profile on the database gave me no cause for concern. It was actually gratifying to see the stark comparison of my “average billed” and “average reimbursed” columns aired publicly. There is a misconception that working in medicine is lucrative, but this data shows that payments to providers are much lower than you might think, especially taking into consideration the cost of running a hospital, medications administered during a visit, and other non-provider related costs of an emergency department stay.
Releasing information to the public opens the door for honest conversations with patients. On one hand, looking at data for a physician with millions of dollars in Medicare claims can cause concern for some individuals, others may look at the data as a positive, desiring a medical provider who performs a certain procedure frequently making them an expert in their practice. Yes, the media hype about the release of Medicare data was sensationalist and focused largely on how much physicians bill and are paid rather than what these charges actually encompass. But, patients taking the time to research Medicare reimbursement rates when it comes to choosing their medical providers are those likely to realize that data interpretation can be complex.
What do you think about Medicare’s release of provider payment data? Are you listed?
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