Medicare places cardiology in top 10 for high payments

Cardiology was among the top 10 provider specialties with the highest average amounts allowed by Medicare, according to the Centers for Medicare & Medicaid Services (CMS). Most of the costs came from medical services rather than drugs administered.

CMS released on June 1 its third annual round of data on Medicare hospitalization use and payments and its second annual round of data on physician and supplier Medicare Part B billing and payments. The 2013 physician dataset included payments and charges submitted for services and procedures by provider. It tallied the total number of services furnished, the provider’s average charge, the average Medicare payment and the average Medicare-allowed amount.

Overall, more than 950,000 distinct healthcare providers received $90 billion in Medicare reimbursement, according to CMS. CMS listed 19,650 providers under cardiology, with an average Medicare-allowed amount per provider for medical services of $296,129.

Cardiology had one of the highest numbers of unique types of medical services among the top 10 specialties, at 53. But it also had one of the lowest average allowed amounts per provider for drug services, at $7,062.

By comparison, medical oncology had 32 types of medical services yet its average allowed amount per drug service totaled $473,926.  

Cardiology also had one of the higher number of office visits by provider type, at 18.1 million for 2013. Approximately half of those visits were billed as Level 4 visits, which CMS described as higher-length office visits. But cardiology was dwarfed by internal medicine for office visits in 2013.

The analysis of hospital utilization and payment determined that Medicare paid approximately $62 billion in payments for more than 7 million hospital discharges. It pegged heart failure as one of the top 10 diagnostic-related groups in 2013.

Two diagnostic group codes—291 and 291, both for heart failure and shock—accounted for 194,697 and 198,483 discharges, respectively, for a combined total of more than $3.5 billion in costs. Still, that was much less than major joint replacements, which cost Medicare $6.6 billion in 2013.