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New database reveals Medicare payments to North Coast doctors

  • Gastroenterologist Dr. Stephen Steady talks with patient Anne Kennedy regarding some dietary issues at his office on Thursday, April 17, 2014 in Petaluma, California. (BETH SCHLANKER/ The Press Democrat)

Steady, a Petaluma gastroenterologist, said the data does not take into account a patient's degree of illness, medical outcomes of procedures and the possibility that more than one doctor in a practice billed Medicare using a single physician's Medicare provider number. The data also does not account for a physician's cost of drugs, which in some cases accounts for a significant portion of the Medicare reimbursement.

Most local doctors do not receive anywhere near the multimillion-dollar Medicare payouts that made national headlines earlier this month when the data was first released — such as $21 million that went to a Florida ophthalmologist in 2012.

Consumer advocates say release of the data by the Centers for Medicare & Medicaid Services is a major victory for patients, who now have a tool that can help them gauge the health care market.

"Consumers are in a health care system that our country's decision makers have decided is going to be market-based. In markets, buyers and sellers both need information and in health care consumers have virtually no information about what they're buying," said John Santa, medical director at Consumer Reports Health.

Santa acknowledged the data is "tricky" and that it will take some time to organize and analyze. Once that happens, Santa said, consumers will have a window they've never had into a local physician's practice.

"Have their doctors done this procedure once or 100 times? Both are of concern," he said. "It will give people an idea of how much their doctors charge. If we do a really good job, eventually we'll see which doctors are playing games with this and which aren't."

With the Medicare data now made public, physicians and their medical associations are trying to provide what they say is much-needed context and a better understanding of the federal government's historic data release.

The $114 million in Medicare payments to the North Bay only includes payments to doctors in the 15 cities in Sonoma, Mendocino and Lake counties. Payments to doctors in unincorporated communities, such as Gualala or Guerneville, were not included in the total because most physicians are centered in the North Bay's larger communities.

Also, for privacy reasons, the federal database excluded procedures performed on 11 or fewer patients.

About a third of the 1,000 North Coast physicians received an average Medicare reimbursement of more than $85,000 in 2012. Nationally, about 25 percent were reimbursed more than $85,000.


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