Medicare Data Shines Light on Billions Paid to Texas Doctors

Texas doctors who treat Medicare patients earned a combined $4.6 billion from the federal insurer of the elderly in 2012, with the state's ophthalmologists and oncologists raking in the most, according to detailed data from the federal Centers for Medicare and Medicaid Services (CMS).

The massive data set, which was released last week, casts light for the first time on the money Texas doctors make for treating the state's more than 3 million Medicare beneficiaries. It lists names of physicians, the cities in which they practice, the type and number of health care services they provided and the average charges for particular services, among other details.

The data show that 342 Texas doctors were each paid more than $1 million by Medicare in 2012. The 20 doctors paid the most by Medicare that year — from a Tyler ophthalmologist who received $6.8 million to a rheumatologist from the same city who was paid $3.1 million — earned a combined $79.5 million from the federal program that year. 

Federal officials touted the release of the data as a step toward increased transparency in Medicare. But it was met with anxiety by health care professionals and medical associations that had fought the disclosure in court for decades until a federal court ruled last year that the information should be public.

Opponents have argued that the data could be misleading because the total payments to doctors could be interpreted as physicians’ take-home pay. They argue it doesn’t reveal what physicians and medical practices apply to their overhead costs, including drug treatments with hefty price tags and staff salaries.

The Texas Medical Association opposed the release of the data, President Stephen Brotherton said, arguing that it does not help patients assess their doctors and instead might leave them with questions.

“Any time you dump data like that with no context, it’s going to be deceiving,” Brotherton said.

The data release comes with some big caveats. For example, doctors and health care providers are differentiated in the data by their “national provider identifier” — a unique code number. But Medicare payments assigned to these identifiers may include claims for services provided by other health care professionals physicians oversee, like medical residents or assistants.

That was the case with the second-highest recipient of Medicare dollars in Texas in 2012. Dr. Reuben Elovitz, an internal medicine specialist in Dallas, was paid $5.1 million by Medicare. A spokeswoman for the doctor said that included reimbursements for services provided by several health care professionals that were filed under Elovitz’s identifier while he was medical director of a Baylor University Medical Center laboratory.

Other doctors attributed their high reimbursements to costs associated with the drugs they provided to patients to treat costly medical conditions. June Cheatham, the practice administrator for Dr. Thomas Bochow, a retinal specialist in Tyler who was paid more by Medicare than any other Texas doctor in 2012, said the $6.8 million the physician received was mostly used to cover costs associated with expensive drugs he uses to treat age-related macular degeneration.

“He’s not out there trying to gather Medicare dollars,” she said. “He’s trying to help patients retain their vision.”

Indeed, more than a third of the 20 Texas doctors paid the most by Medicare in 2012 specialized in ophthalmology.

(Use this sortable table to see how much Medicare paid Texas providers by specialty in 2012. Providers who reported more than one specialty were classified by CMS by the specialty they most commonly billed under. Additionally, medical services that were provided fewer than 11 times were removed from the data altogether to protect patient confidentiality.)

A spokeswoman for Dr. William Brelsford, a rheumatologist from Tyler who received $3.2 million from Medicare in 2012, said his practice accrues about $1 million in debt purchasing drugs to treat Medicare patients with arthritis before receiving reimbursements from the federal program.

Seven oncologists — doctors who treat cancer patients — were also among the 20 Texas doctors paid the most by Medicare in 2012. Oncology was a top field for doctors reporting hefty Medicare payments.  

Several of the top-grossing doctors — including Drs. Alex Ehsan and Darren Kocs, who both received more than $4 million from Medicare in 2012 — both work for Texas Oncology, one of the largest cancer treatment providers in Texas with offices statewide.

“Because many cancer patients are seniors, it’s no surprise that payments for cancer treatment are significant for Medicare," said Ed Bryson, a Texas Oncology spokesman. "We support greater transparency, but the Medicare data released yesterday, without context, does not provide meaningful insight into costs per physician."

Bryson added that the data did not account for the number of patients physicians treat and the type and stage of their cancer, among other costly aspects of treating such patients.

The CMS data released also includes payments made to other service providers in Texas like hospitals, ambulance providers and nursing homes, which received hundreds of millions of dollars in Medicare payments combined in 2012 for services like hospitalization, emergency room visits and nursing care.

Texas physicians received a combined $785 million in Medicare payments in 2012 for a basic service: "office visit with an established patient." 

The data release could lead to increased scrutiny of physicians who are already under the microscope by federal and state watchdogs of waste and fraud in government-subsidized health services.

In a press call last week, CMS Principal Deputy Administrator Jonathan Blum said federal officials were seeking help from the public, health care researchers and reporters to identify spending “that doesn’t make sense” or appears to be fraudulent.

In December, the U.S. Office of Inspector General, which investigates possible fraud and abuse for the U.S. Department of Health and Human Services, recommended that physicians who file the highest reimbursement claims to Medicare be scrutinized.

In Texas, where some providers are already on edge about what could trigger an investigation, the data could be used by the state’s Office of Inspector General, which recently increased efforts to investigate possible fraud among physicians who treat poor children and disabled patients covered by Medicaid.

Stephanie Goodman, a spokeswoman for the Texas Health and Human Services Commission, said her office is still considering ways in which the data may be used, particularly when it comes to Texans who are eligible for both Medicaid and Medicare.

“It will help our researchers with an analysis of care coordination for our dual-eligible population,” Goodman said in a statement. “And it gives OIG a more complete picture of a provider's operations.”

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Disclosure: The Texas Medical Association and the Baylor Health Care System are corporate sponsors of The Texas Tribune. Texas Oncology was a corporate sponsor of The Texas Tribune in 2012. A complete list of Texas Tribune donors and sponsors can be viewed here.