By Meredith Cohn, The Baltimore Sun
9:46 PM EDT, April 9, 2014
Eye specialists, ambulance service providers and clinical laboratories are the biggest recipients of Medicare payments around the country and in Maryland, taking in hundreds of millions of dollars from the federal health program for seniors, according to newly released data.
Federal officials released the data Wednesday for the first time since 1979, offering transparency to the system but drawing criticism from some provider groups who fear that the data could be taken out of context.
"Currently, consumers have limited information about how physicians and other health care professionals practice medicine," said U.S. Health Secretary Kathleen Sebelius. "This data will help fill that gap by offering insight into the Medicare portion of a physician's practice. The data released today afford researchers, policymakers and the public a new window into health care spending and physician practice patterns."
In all, Maryland's doctors and other Medicare providers took in about 2.3 percent of the $77 billion the system paid in 2012 outside of hospitals, according to a Baltimore Sun analysis, slightly more than the state's share for its population and number of seniors.
The top 10 providers in the state, including four ambulance companies, three ophthalmologists and a lab, took in $84 million in payments.
Quest Diagnostics Inc., one of the nation's largest lab companies, received the most money from Medicare in Maryland, with more than $35.6 million in payments for more than 2.9 million services to nearly 290,000 patients. The company has facilities around the state.
Lab work accounts for about 2 to 3 percent of all health care costs, said Wendy Bost, a Quest spokeswoman.
"Clinical lab testing is a cornerstone of health care in the United States and increasingly is used not just to diagnose but treat and manage patients by identifying inappropriate courses of therapy," she said.
The state's second-biggest recipient of Medicare dollars was the ambulance company LifeStar Response with nearly $9.5 million in payments for services to almost 21,000 patients. The company did not respond to a request for comment.
Officials at the Centers for Medicare & Medicaid Services said the numbers apply only to services received outside of hospitals, and that they hope the release would encourage patients and researchers to identify potential waste and abuse in the insurance system, which is paid for by taxpayers. They also said they hope patients can use the information to identify experienced doctors.
However, doctor groups, including one in Maryland, expressed concern that such a large amount of raw data not only has the potential to violate patient privacy but could suggest wrongdoing in practices that have a high volume or offer complex and costly procedures.
"MedChi is concerned that unexplained raw data could lead to confusion and possibly inaccurate and misleading information," said Gene Ransom, CEO of the state doctors society. "Furthermore, MedChi has always been strong supporter of patient privacy, and we need to make sure any data release makes patients' rights a top priority."
Among doctors, ophthalmologists and oncologists were some of the biggest recipients of Medicare dollars in Maryland, with nearly 9 percent and about 6.5 percent of the payments, respectively.
Medicare officials said this could reflect the high costs of related medications. Medicare does not dictate which drugs are used and typically reimburses doctors just over market value for medications and the equipment to use them.
In cases of cancer, doctors often have little leeway on the drugs they use, said Michael Vozniak, president of the Hematology/Oncology Pharmacy Association.
The drugs are expensive because of the high costs of proving they are safe and effective, and sometimes they are made more costly by shortages, he said. When there is a choice, Vozniak said, costs do become a factor, but not the only one.
"You don't want to use the least expensive drug that causes the most side effects because you may end up spending more money to treat the side effects and you've harmed the patient. There are nuances," said Vozniak, who supports the release of Medicare information if it helps devise ways to cut costs.
Several doctors who received large payments did not respond Wednesday to requests for comments. Many of the doctors near the top of the list saw large numbers of patients and were highly regarded.
In all, 490 ophthalmologists took in nearly $158 million in Medicare payments, an average of more than $322,000 each.
Dr. Michael J. Elman of Elman Retina Group, which has three offices in the Baltimore area, was the third-highest recipient of Medicare payments, receiving $7.2 million for services to nearly 2,000 patients, or about $3,600 per patient.
Elman, who did not respond to a request for comment, is a retina disease specialist and has written more than 150 publications on retinal diseases and surgery, according to his website. He is an assistant professor of ophthalmology at the Johns Hopkins University School of Medicine and director of retina surgery at Franklin Square Hospital.
Seventh on the list is Dr. John Thompson, a partner with Retina Specialists of Maryland and a member of Greater Baltimore Medical Center's ophthalmology department. Thompson, president of the American Society of Retina Specialists, received just over $4 million for treating about 1,400 patients, an average of about $3,000 per patient.
He could not be reached for comment, but the retina specialists society released a statement cautioning patients about the Medicare data. The statement said raw data can be "distorted" because retina specialists use sophisticated technology in diagnosis and treatment, and expensive medicines, and reimbursement data does not reflect those costs or the complexity of care for many patients.
For example, the group said retina specialists treat diabetic patients with more complex problems, and imaging, laser treatments and other services are far more costly. Some patients, particularly those in affluent suburbs, have better glucose control than those in lower-income, urban areas.
Other doctors say they also have high patient volumes and complex cases, accounting for their high Medicare reimbursements. Dr. Samer Saiedy, a vascular surgeon at Maryland Vascular Specialists, has two partners and several offices around the region.
He had the sixth-highest Medicare payments in the state, with about $4.7 million in payments for treating 2,227 patients. He said the number might reflect billing by other staff members in the office, though Medicare encourages each doctor to use a unique provider number.
He and the other doctors operate to save limbs using highly technical equipment purchased for his offices. Medicare agrees to work in the cost of the equipment and the specialized support staff because even complex outpatient surgery is less expensive than hospital stays, he said.
"The overhead component is huge," Saiedy said. "But the benefits are huge for Medicare and for patients. They are here two or three hours and they go home and we check on them."
Ambulance service suppliers say their reimbursements likely don't cover their costs for upkeep of equipment and salaries. Sometimes they don't get reimbursed at all, said Mark E. Brady, spokesman for the Prince George's County Fire Department. The county was the fifth-largest recipient of Medicare payments in Maryland at $4.9 million for transporting nearly 8,800 patients, some more than once.
"We'd love to reduce service, but when someone calls 911, we go," he said. "We don't question their reasons. ... It's probably not paying all our costs, but we reap the benefits in that we were able to order new ambulances in the last couple of years."
Baltimore's Fire Department was ninth on the list of state Medicare recipients with $4 million in payments for more than 7,000 patients.
Reimbursement by Medicare and private insurance is used to help offset the cost of the service, said department spokesman Ian Brennan.
The department is working with the city Health Department to help make city residents healthier and "reduce the number of calls for service in coming years," he said.
Baltimore Sun data producer Dana Amihere contributed to this article
Top 10 recipients of Medicare Part B payments in Maryland in 2012:
1. Quest Diagnostics Inc., Halethorpe, clinical laboratory, with 289,568 beneficiaries and 2.9 million services provided, received $35.6 million.
2. LifeStar Response Inc., Halethorpe, ambulance service provider, with 20,839 beneficiaries and 356,601 services provided, received $9.5 million.
3. Dr. Michael J. Elman, Rosedale, ophthalmologist, 1,981 beneficiaries and 38,599 services provided, received $7.2 million.
4. Hart to Heart Ambulance Service Inc., Forest Hill, ambulance service provider, 9,200 beneficiaries and 234,311 services provided, received $5.7 million.
5. Prince George's County Fire Department, Upper Marlboro, ambulance service provider, 8,761 beneficiaries and 100,145 services provided, received $4.9 million.
6. Dr. Samer Saiedy, Lutherville, vascular surgery, 2,227 beneficiaries and 7,050 services provided, received about $4.7 million.
7. Dr. John Thompson, Towson, ophthalmology, 1,439 beneficiaries and 22,219 services provided, received $4.3 million.
8. Dr. Joseph Schwartz, Salisbury, ophthalmology, 2,556 beneficiaries and 29,587 services provided, received $4 million.
9. Baltimore Fire Department, Baltimore, ambulance service provider, 7,058 beneficiaries and 37,879 services provided, received $4 million
10. Dr. Ralph Boccia, Bethesda, hemotology/oncology, 757 beneficiaries and 454,343 services provided, received $4 million.
Note: Location reflects the Medicare billing address but providers might have multiple locations. Data also might reflect multiple providers billing under one provider's code.
Total Medicare payments in Maryland in 2012: $1.77 billion
Total providers: 18,508
Total specialties: 83
Average number of patients per provider: 383
Source: Centers for Medicare & Medicaid Services
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