Do patients care about how much money their doctors make?

I am all for transparency when it comes to health care. So when Medicare announced that it would tell the public how much doctors are paid to treat Medicare patients, my first thought was “hooray.” Another victory for consumer information.

Then I began to think about this in more depth. The Centers for Medicare and Medicaid Services (CMS), in response to a ruling in a federal case in Florida that doctors’ interests do not trump the public interest, said it would begin releasing doctor payment data on a case-by-case basis. The agency added that they would respond to Freedom of Information requests but could not guarantee that every request would be filled.

It’s not clear how the data will be presented. Will all the docs, say, in Casper, Wyoming, who have done knee surgeries be on some list with their payments revealed? Will all the doctors everywhere who’ve performed a particular procedure be listed in some gigantic database?

Doctors themselves are jittery about these potential disclosures. Ardis Dee Hoven, president of the American Medical Association, has urged Medicare to release such data only for the purpose of improving the quality of health care services and with “appropriate safeguards,” whatever that means.

As a journalist, I see all kinds of possible stories emerging once enough data is available, and that may be a reason why journalists hailed the CMS announcement. Data can be used for exposés of the priciest doctors, or to identify outliers for particular services.

In some ways, I really don’t care about the doctors’ concerns. As a group, they’ve never been forthright about their incomes and have lobbied hard over the years to protect their bottom lines. Why should we expect anything different?

Still, I keep returning to the question: What will the data do for the average person? Can a person really use it to make decent health decisions? And will the release of payment information make a dent in Medicare spending? MedPage Today reported that in 2012 Medicare paid $69.6 billion to some 800,000 providers. That was only 12 percent of Medicare’s overall fee-for-service spending. The real bucks to be saved are found in what Medicare pays hospitals.

I can see some Medicare patients using the payment data, especially if they are enrolled in Medicare Advantage. Given the cost-sharing features of these plans, knowing the prices of various services from different doctors would be very helpful.

It is less clear, however, that having access to Medicare physician payment information will be useful to someone who has one of those cheapie health insurance policies offered on the state exchanges — the ones that call for 30 percent or 50 percent coinsurance — since prices for Medicare patients may be different from what doctors charge commercially insured patients.

But we also run into that old problem: Price doesn’t always equate with quality. At this point, we don’t know how or if Medicare plans to couple its payment data with quality measures, if at all. As I reported in another column on tiered-networks, officials from Independence Blue Cross said they couldn’t use quality data for placing many doctors in their price tiers because there was no public database assessing the quality of specialists.

Then there’s the problem of data overload. Patients are likely to shrug off payment data as just another set of numbers to consider in carrying out a very complex task. Many patients like their doctors and are loathe to blame them for the woes of the health care system. Most will think what doctors are paid by Medicare is just fine.

The attention showered on this potential data goldmine seems misplaced. While CMS is taking an important step towards payment/price transparency, the data collected is limited to Medicare. In addition, as I’ve noted many times before, the disclosures that may be the most useful are those from Medicare and insurance companies that tell people what services they received, the amount their insurer paid and, most importantly, how much they owe. We still have that confusing EOB problem! Until there’s real transparency in things that really matter to patients, it’s hard to declare a consumer victory.

Trudy Lieberman is a journalist and an adjunct associate professor of public health, Hunter College, New York, NY. She blogs on the Prepared Patient blog.

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  • Dr. Drake Ramoray

    The disclosure of payment data in it’s current form isn’t that big a deal as this author has cited. You can make a privacy argument sure. Within my practice all it would really tell you is how long the provider has been practicing (the senior doc in our group takes virtually no new Medicare so he would have the lowest numbers).

    That being said if you think all this data isn’t being collected to squeeze underperforming providers I have some beachfront property to sell you in Wyoming. Even the early articles about it are talking about linking outcomes to the database.

    http://www.huffingtonpost.com/2014/04/09/medicare-paid-doctors-millions-database-shows_n_5115393.html

    “Medical practice would have to change to accommodate big data. Acting as intermediaries for employers and government programs, insurers could use the Medicare numbers to demand that low-performing doctors measure up. If the data indicated a particular doctor’s diabetic patients were having unusually high rates of complications, that doctor might face questions.”

    Umm.. no thank you. All insurance, not just Medicare. Compare my fairly rural practice with higher rates of poverty, poor education, and baseline increased complication rate to practices in the affluent suburbs with a healthier populations. No thanks. Even if I stayed, why would I keep a continually non-compliant diabetic patient in my practice who is just going to get me audited? It costs more money to take care of sicker patients. There is a surprise.

  • SherryH

    If they are going to disclose salaries for doctors they should also include salaries/bonuses for top hospital administrators. Especially for those hospitals using a non-profit status for more and more money.

    • ninguem

      Guidestar.org

      Log on. The basic service is free. Paid service gives you more detailed data back further in time, which some professionals might need, but not for me.

      If you’re a nonprofit, you file a Form 990 with the IRS.

      The IRS forms are a public document, and are available on-line.

      In the Form 990, you will find the salaries of major officers of the nonprofit, highest paid employees, highest paid contractors.

      If the hospital is a nonprofit, you can look it up and find the salaries of the top administrators.

    • Dub

      SherryH nailed it. There should be a greater emphasis paid on what administrators are paid and the amount paid to nonprofit health insurance company administrators. Unfortunately people will look at the figures and assume this is what the Doc is pocketing from Medicare. From looking at the figures there should be an influx for training in ophthalmology.

  • SherryH

    Personally I’m not interested in how much my doctor makes. That aside, you can find salaries of cops and teachers fairly easily. They are paid for with tax payer dollars, and so are health care professionals paid for by Medicare. Of course, they don’t pay the office overhead some doctors do, and most patients, myself included, just don’t understand what that entails.

    • NewMexicoRam

      My office expenses (staff, supplies, rent, etc) are about 70% of my receipts.
      20 years ago, it was around 50%.
      See what Medicare has done to us.

  • NewMexicoRam

    That’s okay. When patients ask me about the numbers, I’ll just tell them to subtract 90% of the amount and that’s what I get.
    I believe I will be hearing a lot of sympathy from my patients at that point.

    • NewMexicoRam

      OK, I just looked up my profile for 2012.

      $40, 931.

      And straight Medicare is about 25-30% of my practice, another 45-50% is Medicare Advantage.

      Guess I won’t be in the top 1% on this scale, either.

      • Suzi Q 38

        Are you saying that you made $40,931.00 total for 2012??

        Was that net, after subtracting the 25-30%?

        • NewMexicoRam

          No, that’s what I earned on straight Medicare. The patients either paid the other 20% of what Medicare doesn’t, or more likely they had supplemental insurance to pay that 20%. I also see Medicare Advantage, Medicaid, and commercial patients. Now, I do have expenses and staff to pay, so I figure my take home would be around 20% of what Medicare pays, for just the Medicare patients.

          • Suzi Q 38

            Do you take this much medicare by choice?
            I notice my PCP having a lot of medicare patients.
            I wonder if I am one of the few regular PPO patients that he has.
            I still go to him, as i have for the last 12 years.
            My husband says that I am braver than he is, as he won’t to to that part of town. LOL.
            I didn’t realize that medicare paid so little.

            I am nicer to my doctors lately.

          • buzzkillerjsmith

            If you think that’s bad, try to find out what Medicaid pays.

          • Suzi Q 38

            A friend of mine is a pediatrician in California.
            She said that medicaid pays approximately $15.00 per visit. Is this possible?
            This is why she sees about 45 patients most days.
            Does the government think that serving the poor should be a “given?”
            $15.00 X 45 patients is only $675.00. Is that enough to pay the physician, nurses, receptionist, and pay for your office and utilities???

          • Kristy Sokoloski

            Suzi Q,

            Interesting about what you said that your Pediatrician friend said about how much Medicaid pays her per visit. I have a friend who uses Medicaid (she lives in another State) and now it has me curious to find out just how much they pay her doctors for the care she needs. I might have to ask her about that to see. But if what your friend said is true then that further explains why so many doctors are not wanting to accept the care of Medicaid patients.

          • Suzi Q 38

            She works for a very busy clinic, in a poor area of a large city. There are several doctors at the clinic. She expressed concern that not only was the pay low, but she was expected to see and be responsible for so many patients. Also, her competition was coming from NP’s who accepted less pay.

          • Kristy Sokoloski

            Wow. Have you seen the movie Escape Fire? I so want to see the movie. It did a pretty good job of explaining even more what is going on with the healthcare system in this country.

          • Suzi Q 38

            I will try to find and see it.
            Thanks.

          • Kristy Sokoloski

            You’re welcome. Used to be able to rent it online from the site for the movie: http://www.escapefire.com for $.99 but don’t know if that’s still the case. I will double check to see when I look at their Facebook page again next time so that I can find the link. They have also been putting up on their Facebook page some other information that further goes in to things about the Healthcare system that couldn’t be fully discussed in the film. Too bad much more was not covered but I guess there’s too much going on to try and cover it all. But when I saw the previews for this I was like “wow”.

          • querywoman

            Yes, it’s possible. I left Texas welfare about 13 years ago. Before I left welfare, the state had raised what it would pay pediatricians for a comprehensive annual physical and screening to $29!
            That’s why I preferred that my clients take their children to the public clinics, where the physicians are son salary, to get them done right.
            You can find out what your state pays Medicaid doctors for procedures by filing your state’s equivalent to a federal Freedom of Information Request.
            It’s possible for private Medicaid doctors to make lots of money, by adding costly procedures for everyone.
            I went to work in welfare in the early 1990s. The social worker in my training office told me about an interesting ripoff Medicaid family doc a few doors done.
            She required kids with minor illnesses who got like 10 antibiotics to come in for unnecessary followups three or four days later.
            Then she got them “locked in” to using only her because of excessive office visits.
            Patients could be locked in to one doctor or pharmacy because of excessive use.
            I think locking in to a certain doctor went away when Medicaid managed care came into being.

          • Suzi Q 38

            I have heard of doctors requiring multiple visits in order to bill more for services.
            My doctor used to do this with me, but I pointed out that I had PPO insurance. I can tell that the majority of his patients are medicare and medicaid patients. My family and friends ask me why I still go there…I like him, he puts up with my direct “talk,” and I hate to change doctors. I will have to come to terms with that, as he is only a few more years older than me. He works 10 times harder, so I am sure he is tired of the rat race and ready to retire soon.

          • querywoman

            When the unethical doctors get caught at one scheme, they come up with another, just like other fraudsters.
            The family doctor near our welfare office who was getting clients locked in to her was taking advantage of people who didn’t know what’s going on.
            Those pediatric annual physicals for children on Medicaid are supposed to include a bunch of checkpoints, like a lead screen. The private doctors don’t do them right because they don’t get paid much.
            I once told this to a fairly good family practice doctor who has own urgent care clinic. He may not have known what services for which his tax dollars should pay.
            I trusted him, even if he didn’t do all that stuff, to evaluate a child for development stuff and refer to a children’s hospital when necessary.
            Some doctors would rather treat Medicaid patients free. You can see why!

          • Suzi Q 38

            I remember “back in the day,” before the Internet, we had these “lists” of doctors who were caught with medical fraud. I think Ralph Nader used to sell a book with the names of doctors who were caught.
            Some were doctors that I used to know, when I worked in the big city. I didn’t know whether to be surprised or not.

          • Kristy Sokoloski

            I agree with your statement about the amount Medicaid pays the doctors. I will add further to that is that for those of us who have insurance through other companies that offer plans like the PPOs (of which my insurance is one of these) and let’s see if we can find out how much the doctors that take these insurance plans get paid. I know on the EOBs from my insurance I am told how much they pay each of my doctors for services they render to me. And it also tells me what my part of the cost-sharing portion is.

            My relative is of the opinion that since our insurance plan pays a good majority of the bill to the doctors that render services that they don’t need to do their part of the cost-sharing as outlined by our plan. Or with any insurance that requires it for that matter.

      • EmilyAnon

        Medicare released their average yearly payment per doctor by state:

        New Mexico $57,000

        California $110,000

        Florida $144,000

        “Reimbursements to doctors who provide Medicare services in 2012 ranged from nearly $21 million to a single Florida ophthalmologist to the $27,000 for the average anesthesiologist, according to the first look at government payment data in 35 years.”

        http://www.usatoday.com/story/news/nation/2014/04/09/government-releases-medicare-physician-payment/7462923/

  • buzzkillerjsmith

    Ho hum.

    “None of us really understands what’s going on with all these numbers.”–David Stockman

  • guest

    Woohoo! I made $19,000 last year!

    • guest

      Oh…wait. The hospital billed $19,000 but Medicare actually only paid $10,000. Bummer.

  • ninguem

    This Medicare data dump. Does anyone know if that’s just straight Medicare, or are the Medicare HMO’s, Medicare Advantage Plans somehow folded into this as well?