Medicare pay: 200 cardiologists clear $1M, with one topping $18M

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 - Money in the Pocket

At least 200 cardiologists received $1 million or more in Medicare reimbursement in 2012, according to data made public April 9 by the Centers for Medicare & Medicaid Services (CMS). The top earner’s reimbursement exceeded $18 million.

CMS made data available through its website on approximately 880,000 physicians and other providers whom Medicare paid for patient care in 2012. The list included 22,241 cardiology providers, 1,886 thoracic surgery providers and 1,117 cardiac electrophysiology providers.

Almost $5 billion of the $77 billion in Medicare reimbursement in 2012 went to cardiologists, according to a breakdown of the top 15 medical specialties by the Wall Street Journal. The average payment was $223,248.

A review by Cardiovascular Business showed huge gaps in reimbursement even among those receiving seven-figure payments. The second highest earner for cardiology, for instance, received about $4.5 million.

By contrast, in the cardiac electrophysiology specialty, Medicare paid out $204 million for an average payment of $182,641. Only one electrophysiology payment reached the $1 million mark, and a handful of physicians received less than $100 for the year.

Four physicians in the cardiac surgery category and one physician in the thoracic surgery category received more than $1 million as well.  

CMS released the payment and billing data in an effort to make pricing more transparent to patients and to educate them about the cost of care, the U.S. Department of Health and Human Services (HHS) claims. Jonathan Blum, HHS principal deputy administrator, argued that the public information “will allow a more informed debate about the appropriate Medicare payment for particular services.”

The American College of Cardiology and other societies have opposed the public release, warning that it could confuse patients and, without providing context and risk adjustment, mislead them. The societies raised concerns about the accuracy of the data, which physicians have not had the opportunity to verify. They also pointed out that the payment data does not inform patients about outcomes and quality of care.

Users of the database may not understand the complexity of the Medicare claims system, the American Medical Association has emphasized. For instance, services for a variety of healthcare providers may be filed under a physician’s National Provider Identifier and charges don’t necessarily equate to the amount paid. These factors could affect the raw number seen by users of the database.

Numerous reports have focused on the upper echelon of payments, noting that a small fraction of doctors accounted for almost a quarter of the Medicare payments. CMS has said in the past it will scrutinize outliers to identify possible overuse or fraud.