Medicare's real doctor payment problem

2014-04-11T00:00:00Z Medicare's real doctor payment problemLos Angeles Times Arizona Daily Star
April 11, 2014 12:00 am  • 

The following editorial appeared Thursday in the Los Angeles Times:

The news that a small percentage of the country’s physicians collected billions of dollars from Medicare in a single year may or may not be a testament to individual greed; some of the top recipients are under investigation for allegedly bilking the system, while others work long hours delivering costly care.

But it is a powerful reminder that the program needs to stop rewarding doctors for the quantity of care they deliver rather than the quality.

Happily, there’s a bipartisan plan to do just that; unhappily, lawmakers haven’t been able to agree on how to cover its cost. If Congress needed any further incentive to settle its differences, the fact that 1,000 doctors raked in $3 billion from Medicare should provide it.

The Obama administration released details Wednesday on $77 billion worth of payments made in 2012 by Medicare Part B, which pays for doctors and other health-care professionals. Part B is financed mainly by the government, so taxpayers have a keen interest in the program’s financial integrity.

The new data, however, reveal some alarmingly large payouts. For example, more than a dozen physicians each collected more than $10 million from Medicare in 2012, and thousands of specialists in four disciplines — three cancer-related fields and ophthalmology — averaged more than $300,000.

It’s risky to leap to conclusions just from the numbers, given that the payments may include reimbursements for expensive drugs that doctors provided or services by multiple members of a team.

Yet the concentration of payments is astounding — a mere 2 percent of the doctors participating in the program took in almost a quarter of the fees. 

Earlier this year, the top Republicans and Democrats on three influential congressional committees came up with a plan that would have encouraged Medicare doctors to switch from fee-for-service to alternative payment plans that reward quality and efficiency. It also would have replaced an ineffective formula for slowing the growth in Part B costs by cutting the fees paid for most doctors’ services.

Unfortunately, the plan stalled because of a dispute over how to pay for the measure, and Congress enacted minor Medicare reforms that left the fee-for-service system intact for at least another year.

The new disclosures about enormous Medicare payouts should send lawmakers back to work on the bill to steer doctors into payment plans that yield better results for patients — and taxpayers.

Copyright 2014 Arizona Daily Star. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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