How to Field Patient Questions on Your Medicare Payments

Laird Harrison


June 05, 2014

In This Article

More of Your Financial Details Are About to Go Public

Last April, the Centers for Medicare & Medicaid Services (CMS) released 2012 data on Medicare payments to physicians by specialty, as well as individually. The news was a jaw-dropper, especially for ophthalmologists. Eye doctors, whose procedures are so low in profitability that many hospitals don't want them on staff and many Accountable Care Organizations don't want them as members, topped the list of high earners, ahead of oncologists, cardiologists, and orthopedic surgeons.

The news looked outrageous. One Florida ophthalmologist got $21 million in reimbursement from Medicare, the New York Times reported on April 9.[1]

"Sliver of Medicare Doctors Get Big Share of Payouts," the headline said, and it provided a list ranking ophthalmology as the specialty taking in the most Medicare dollars -- $5.6 billion in 2012.[2] Many other news organizations also jumped on the story.[3]

As eye doctors rushed to point out,[2] the initial headlines gave a wrong impression. Much of that $5.6 billion flowed right through their hands and into the bank accounts of pharmaceutical companies. A full $1 billion went to pay for the macular degeneration drug ranibizumab, which can cost $2000 per injection. The recommended dosage is one injection per month.[4]

That brouhaha is already fading from the news, but if you expect an end to such reports, think again. Digital technology is making it easier to disseminate information of every kind, and the pressure for access to it is mounting.

"Surgeons at every stage of their practice should get accustomed to the fact that we're in an open-books world," says John Pinto, an ophthalmology practice management consultant based in San Diego, California.

The next big data dump is already on the horizon, when the Sunshine Act reveals financial relationships between physicians and partners in industry.

"The release of the reimbursement data, and the impact of that and the attention it received in the press, should foreshadow what's likely to happen when the Sunshine data are disclosed," says Michael Repka, MD, MBA, Medical Director of Government Affairs for the American Academy of Ophthalmology (AAO).


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.