Medicare paid out hundreds of millions of dollars to a small subset of physicians in 2013, but most of those payments to top Medicare billers covered the costs of drugs administered to patients in clinicians' offices.
The drug payment data highlight long-standing concerns about Medicare's system for paying doctors for drugs used in their offices and outpatient centers. But interpreting the data is complicated, because they lump together doctors who may be involved in questionable practices with productive physicians in narrow specialties that require intensive medication use.
The 100 top-billing Medicare doctors received more than $655 million from the program in 2013, according to a Modern Healthcare analysis of CMS' Medicare Part B data released last week. About 67% of that total, or $439 million, went toward Part B drugs administered in doctors' offices. Most of the highest-paid doctors were oncologists and ophthalmologists, who often use expensive drugs in their offices.
Drug costs accounted for only 12% of the $75 billion Medicare Part B paid to all 900,000 providers in 2013.
This is the second year the CMS has released Part B data on payments to individual physicians and other providers, after Dow Jones & Co. sued for the data and the Obama administration adopted a new healthcare transparency initiative.
In the latest data release, the CMS broke out payments for drugs versus payments for medical services, partly in response to the American Medical Association's complaint that last year's data release created a “misleading perception that drug reimbursement was physician income.”
Under Part B, Medicare reimburses physicians for drugs used in their offices and outpatient centers by paying for the drug's average sales price, plus 6% to cover overhead.
That guaranteed additional percentage for physicians has been criticized because it encourages them to buy the highest-cost drugs when cheaper drugs may be just as effective.
For instance, studies have shown that Medicare could have saved $18 billion over 10 years if doctors used the drug Avastin for macular degeneration instead of the more-expensive Lucentis.
“The incentives for physicians to use the more expensive drugs are very large,” said Paul Ginsburg, an economist and health policy expert at the University of Southern California. “These data will help show the lack of a system to attempt to contain costs for physician-administered drugs.”