Medicare database reveals top-paid doctors making millions

By Serdar Tumgoren

Associated Press

Published: Wednesday, April 9 2014 12:00 a.m. MDT

"We believe that the broad data dump ... has significant shortcomings regarding the accuracy and value of the medical services rendered by physicians," AMA president Ardis Dee Hoven said. "Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences."

The AMA had asked the government to allow individual doctors to review their information prior to its release.

Over time, as researchers learn to mine the Medicare data, it could change the way medicine is practiced in the U.S. Doctor ratings, often based on the opinions of other physicians, would be driven by hard data, like statistics on baseball players. Consumers could become better educated about the doctors in their communities.

For example, if your father is about to undergo heart bypass, you could find out how many operations his surgeon has done in the last year. Research shows that for many procedures, patients are better off going to a surgeon who performs them frequently.

The data could also be used to spot fraud, such as doctors billing for seeing more patients in a day than their office could reasonably be expected to care for.

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.

Such oversight would probably accelerate trends toward large medical groups and doctors working as employees instead of in small practices.

Melgen, the top-paid physician in 2012, has already come under scrutiny. In addition to allowing the use of his jet, the eye specialist was the top political donor for Menendez as the New Jersey Democrat sought re-election to the Senate that year.

Menendez's relationship with Melgen prompted Senate Ethics and Justice Department investigations. Menendez reimbursed Melgen more than $70,000 for plane trips.

The issue exploded in late January 2013, after the FBI conducted a search of Melgen's West Palm Beach offices. Agents carted away evidence, but law enforcement officials have refused to say why. Authorities declined to comment on the open investigation.

Associated Press writer Kelli Kennedy in Miami contributed to this report.

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