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posted: 5/3/2014 5:01 AM

Medicare transparency offers limited perspective

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Much has been made of the Medicare physician payment "data dump" that occurred on April 9. Pursuit of transparency by America's single largest purchaser of health care is laudable, but the way this information is being presented lacks some important elements of context. I'd like to share a bit about what this material really means.

If you look up my name in this new database, you'll see the amount of reimbursements associated with my "national provider identification" number -- the technical ID number I've been assigned in order to submit a claim after I treat one of my Medicare patients. You won't see information about the care I provided, the patient's illness or a host of other issues that make each episode of medical care unique.

You won't see any information about how much it costs to provide care, either. Everything from gloves and tongue depressors to staff salaries and medical liability insurance is paid for by reimbursements like these.

Another hitch is that many doctors in institutional and community settings also use their NPI number to bill for a medical resident or allied health professional under the doctor's supervision. As a result, you can't tell by looking at the data if it applies solely to the physician or it includes charges for a whole medical team.

The data release also offers very little perspective on how much a doctor actually "earns" from Medicare. Medicare reimburses physicians in my area $42 for a basic office visit. A physician will generally receive about $17 of that after expenses. The information Medicare is now sharing doesn't tell the whole story.

Eldon A. Trame, MD

President Illinois State Medical Society


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