A closer look helps explain why some doctors received more than others. For instance, in Philadelphia, where Horwitz and Weinberg are based, total reimbursement to individual radiation oncologists ranged from $237 to more than $2.7 million; in San Francisco, payments fell between $7437 and $33,177. What is the explanation? Looking at one diagnostic code (77421, using stereoscopic X-ray guidance to guide radiation therapy), they found that one physician at an academic practice in Philadelphia performed this service 616 times on 321 patients, billing an average of $63 per treatment to Medicare, and receiving $15. But at a suburban private practice, for this same service, a physician billed $300 for each treatment performed 1744 times, and was given $69. Here, the difference stems not from geography, but more the type of practice.
Furthermore, Medicare pays for much more than just physician services it also covers the cost of drugs, tests and facility fees. In an accompanying editorial in the same issue of the journal, Gail R. Wilensky, PhD, senior fellow at project HOPE and a former administrator for CMS, notes that these data do not provide any information about procedures covered by other insurers, such as private companies and Medicaid. Making major changes to health care spending based solely on physician reimbursement data from Medicare would miss the larger picture, note Horwitz and Weinberg.
It helps to have these data to promote transparency in health care spending but only if we acknowledge what they can and cannot reveal, the authors conclude. "Used carelessly," these data "may provide great headlines, gossip, and controversy but will offer little insight, thereby hinderinginstead of promoting
|Contact: Diana Quattrone|
Fox Chase Cancer Center