It was the largest data release of its kind to date and hailed by reform supporters as a first necessary step, but area doctors say the scores of names and numbers in April’s Medicare Payments to Providers list means almost nothing.
“What you have there is just data. Data is just numbers,” said Dr. Tom Landholt, founder of Springfield-based PatientCare Family Clinic. “Information is data in context. Knowledge is an independent reaction to information.
“Without any context, you just have a bunch of numbers on a spreadsheet.”
Landholt, now an internal consultant for Mercy in St. Louis, said the raw numbers released by the Centers for Medicare and Medicaid Services paint an incomplete story.
For example, in Springfield, the largest individual payout went to Dr. Mary Kay Vaske, a pathologist with Mercy Clinic Pathology-Springfield who was listed as receiving $3.5 million in 2012 for treatments including thyroid and blood tests. In reality, Vaske, who no longer works for Mercy, was lab director for Mercy in Springfield, Lebanon and Mountain View and clinic director of Smith Glynn Callaway, and all tests were billed under her physician identification number.
As then owner/operator of his independent practice, Landholt said his bottom line benefited from the reimbursement, even though he didn’t always conduct the work himself.
“The numbers don’t even reflect accurately in small clinics,” said Landholt, who tallied $8,857 in 2012 Medicare reimbursement. “Mine were mostly office visits which could have been done by me or a nurse practitioner.
“Just because I signed off on the work doesn’t mean I did it.”
The list based on CMS data shows the dollar amounts doctors and other medical providers received in Medicare reimbursements in 2012, along with other data including their specialties.
Only procedures that providers performed on more than 10 Medicare patients were included.
The April data disclosure only came after a lengthy legal battle by Dow Jones & Co., publisher of The Wall Street Journal, to overturn an injunction that had prevented the government from publicly releasing Medicare payment information on individual doctors.
The Wall Street Journal then compiled a searchable database of the information. Despite media reports touting the numbers as actual doctor pay, the Wall Street Journal cautioned readers, “while the data set is the first to show what doctors are paid for specific procedures billed to Medicare … the records don’t follow doctors, or their patients, over time, and don’t capture the intricacies of increasingly complicated medical practices that may house multiple providers in a wide variety of arrangements.”
Numbers breakdown CMS paid out $59.9 million to Springfield health care professionals in 2012, according to data from the federal agency. The largest Queen City payment was $6.1 million, paid to Mercy Hospital Springfield for its ambulance service supplier. Of that funding, $2.9 million went toward advanced life support, while $2.1 million was paid out for ground mileage and $416,822 for basic life support.
Bob Patterson, Mercy executive director of emergency medical services, said the numbers are a somewhat accurate picture of service.
“If that looks high for service it’s because these numbers don’t just cover Springfield, our service is in parts of 14 counties across the region,” he said.
“We extend all the way out to Shannon County and down into Stone County and even Carroll County, Ark.”
Patterson said, on average, EMS responds to about 55,000 calls a year, but the $6.1 million figure only reflects costs for Medicare and Medicaid patients.
According to the database, Mercy’s ambulance service supplier performed 9,623 advanced life support runs for an average reimbursement of $303.82 each. It also logged 319,957 billable ground miles with an average payment of $6.45 per trip.
“Medicare has a base charge that increases with the level of care,” Patterson said. “Ground miles or ‘loaded miles’ are only miles in which we have a patient aboard.”
Ambulance reimbursement information was not available by press time from Springfield health system CoxHealth, but Patterson said Mercy’s patient load is typical for a hospital its size.
Other area notables include former Mercy hematologist and oncologist Patrick Gomez, who’s listed as receiving $1.73 million in 2012 – the second highest individual payout locally – but Mercy spokeswoman Sonya Kullmann said the listing is a billing code error. Gomez practiced in Illinois in 2012 and hasn’t worked for Mercy since 2007.
About $1.71 million was billed under ophthalmologist Leo Neu’s name and his practice, Mattax Neu Prater Surgery Center LLC, was paid $1.4 million for its ambulatory surgical center.
Outside the Queen City, the largest payment went to Ozark-based Mobile X-ray Services LLC, dba Kosma Mobile X-Ray & Ultrasound Services, for $1.87 million. Director of Operations Amber Sims said the majority of fees cover trips by the company’s fleet of vehicles to area nursing homes, county jails and the morgue.
“We bill what Medicare will allow for the transportation of equipment and then for each exam based on its allowable rate,” she said.
In 2012, the mobile service preformed 7,531 trips covered by Medicare at an average of $155.53 per session. The majority of individual X-rays were chest X-rays with 4,624 performed at an average reimbursement value of $7.61 for $35,188 total.
The big pictureIn total, Medicare disclosed more than $77 billion in 2012 payments to 880,000 doctors nationwide, but much of that money went toward hospital overhead. CMS data shows the largest group of doctors – 17,067 ophthalmologists – were reimbursed an average of $327,239. However, when the Wall Street Journal calculated pay for actual work vs. expenses, about $230,083 went toward hospital overhead while only $97,156 went toward the cost of the actual procedure or medicine provided.
“Physicians are on a salary and the money reimbursed is not going to them, it’s going to the hospital,” said Dr. David Barbe, regional division president of Mercy Clinic Springfield. “This data tells us very little. So what if they were paid $1 million. What does that mean?
“That figure bears little connection to what a doctor is paid or the patient care that is provided.”
Kullmann said not all doctors are salaried, but rather paid through a variable physician compensation plan unrelated to Medicare reimbursement.
Barbe, who also is immediate past chairman of the American Medical Association Board of Trustees and a family physician in Mountain Grove, said health care providers would rather see a value equation where cost is compared to quality, not just dollar figures.
“Eventually, we hope not just to know the total dollar figure, but what you get for that dollar,” he said. “How much does it really cost to take care of a population?”
Since a 2005 Physician Group Practice project pilot program, Mercy has used an ACO model, or accountable care organization, to track patient quality and hospital improvement.
“Under the model, Medicare projects how much it thinks it will cost to cover a population,” he said. “Then, if Mercy hits quality markers and spends less on the population than projected, Medicare shares that savings back with the health system.”
For example, if Medicare projects a cost of $1 million to cover Springfield and Mercy performs well and only spends $800,000, the remaining $200,000 would be shared back with Mercy.
Barbe said under the original PGP pilot with 10 participating hospitals, the split was 80/20, with Mercy receiving 80 percent. Currently, the program is a 50/50 split once the health system saves more than 2 percent of projected totals.
“The first year under the official program, we had no savings and the second year we don’t know yet,” Barbe said, noting Mercy won’t receive 2012’s results until later this year. “In the follow-up and revisions to the program, there is a lag of about one year.”
Spokeswoman Kullmann said in the fifth year of the pilot program, Mercy achieved 100 percent on all quality markers and saved more than $3.3 million on care. Over the five-year period, Mercy saved the government a total of $17.6 million on the southwest Missoui Medicare population.
Barbe said Mercy Springfield acted as a pilot under the ACO model for the entire system, saying the St. Louis-based health care provider is taking the model systemwide.
The shared savings plan doesn’t cover all Medicare patients, however. Barbe said it covers about 35,000 southwest Missouri patients, but doesn’t take into account Medicare advantage patients who pay for services differently.
“This data dump is a small slice of the bigger picture and not a good slice at that,” he said.
“Care needs to be evaluated on value and quality for the cost. Neither of those factors were present in the data dump.”
