Medicare pays hundreds of millions to Maryland providers

Ambulance companies, labs, ophthalmologists and oncologists earn the most in Medicare payments in the state

April 09, 2014|By Meredith Cohn, The Baltimore Sun

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.

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