Tracking Medicare money to Idaho providers

Recent payment disclosures help shine a light on health care in Idaho.

adutton@idahostatesman.comJuly 5, 2014 

PATRICK DAVIS

  • SOME IMPORTANT CAVEATS

    Here are things to keep in mind about the Medicare data:

    • Medicare payments to doctors and other providers in 2012 don't tell us much about profit or income. For one thing, private insurance isn't in the recent disclosures - and for many doctors, that's a lot of their business. Doctors who don't see many Medicare patients may not even show up in the data.

    • The payments don't always reflect the real cost of performing a knee replacement or giving a shot.

    • Many average payments are orders of magnitude less than the provider's average charge. Others are right on the button. Several Idaho medical providers billed Medicare $10 and got back $10. Others billed more than $100 - and got back $10.

    • The data also leave out what Medicare paid to the hospital where a doctor was working.

Do you ever wonder how much your doctors get paid by Medicare? And what they're doing for that money? Curious how many seniors in Idaho have gotten cataract surgery and what that cost Medicare?

The Centers for Medicare and Medicaid Services released data this spring that gave the public a never-before-available glimpse into the business of health care. The data reveal Medicare's charges, payments and services linked to health care providers in Idaho and across the country.

The data offer some answers - with a big helping of caveats - to questions about who's getting Medicare money, and for what.

The Statesman analyzed 36,000 lines of data for Idaho and discovered some surprises - such as a 2:5 ratio of women to men among Medicare providers, and a 1:5 ratio in their total Medicare payments.

Which doctors cost Medicare the most?

Depends how you look at it. The top 10 highest average payments for all procedures ranged from $126 for opthalmologists to $447 for cardiac surgeons.

But some of the highest payments went to ambulance suppliers such as Ada County or outpatient surgery centers - not individual doctors.

In case you're wondering who got the lowest payments, it's laboratories. They averaged $17 per service. Pediatricians, independent audiologists, chiropractors and physical therapists also averaged $25 or less.

For total Medicare spending in Idaho, family doctors as a profession claimed the most dollars - about $15.3 million.

Ophthalmologists were No. 2 for highest total payment as a profession, at $14.7 million.

Total Medicare doctor and supplier payments in 2012:

Does that mean family doctors and specialists made big profits?

Not necessarily. Family doctors saw a lot of patients - about 250,000 under Medicare - in 2012 and performed more than two services per Medicare patient that year. They didn't bill Medicare the most, or get paid the most, as a profession.

Ophthalmologists in Idaho had among the highest payments. Like other specialists in the Medicare data, a lot of their charges were for giving patients injections or medication.

Dr. Leo Harf of Intermountain Eye Clinic was among the top-paid Treasure Valley doctors. Because he specializes in diseases like macular degeneration, about 98 percent of his clients are on Medicare, said Angie Cornell, office manager for the practice's Nampa office.

The main reason his payments were so high is that his patients get injections of "extremely expensive" drugs, Cornell said. Profits on those drugs from Medicare are "pretty close to zero," she said, partly because it takes anywhere from a month to several months to get Medicare reimbursement, during which time interest accrues on the drug purchas.

"His drug expenses are astronomical anymore," she said.

Vials of one medication can cost $2,000 each, she said. Harf has tried to use cheaper versions - $65 per vial, for example - by ordering them from compounding pharmacies. But that's not ideal, she said, because patients using that drug have to make two office visits - one to get the prescription, another to get the drug injected after the prescription is filled.

Why is one extra office visit a problem? The doctor has patients who drive from Sun Valley, McCall and Baker City, Ore., she said.

How can I get the most bang for my buck as a health care consumer?

We can't answer that from this data. But medical providers in some counties, particularly in North Idaho, charged more than their peers for an office visit.

Average Medicare charge for an office visit in 2012:
Note: Counties with zero office-visit charges in 2012 are not shown.

Ada County got the largest share of Medicare money for the state - more than $55 million - but its medical providers ranked No. 7 for average payments, and they charged the fourth-highest rates in the state for all services.

Audrey Dutton: 377-6448, Twitter: @IDS_Audrey

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