Take a look at the results for Louisville and Kentucky.

Our colleague Terry Boyd at Insider Louisville was probably the first out of the block this morning to report on the local results of the much-debated, long-opposed, and likely system-changing publication by the Centers for Medicare and Medicaid Services of the amounts of money charged by and payed to individual physicians and other providers for some Medicare patients. This previously top-secret financial and utilization information had not even been available to other physicians let alone the public.

Long opposed by organized medicine as a violation of individual physician privacy, the public has gotten used to, indeed gained an appetite for such information about hospitals, nursing homes and the like. This is part of the movement to increase medical safety, quality, and efficiency. It also has been very helpful for identifying medical fraud and abuse. I predict that the release of physician payment data will have as much earth-shaking effect as last year’s release of hospital payment data illustrated by the now-famous article in Time Magazine, “Bitter Pill: Why Medical Bills Are Killing Us,” by Steven Brill.

There will be much to learn from this extensive database. It is huge! My tricked-out Mac chokes on the size of it. You can look up individual physicians for a more detailed breakdown on the Washington Post Portal referred to by Terry Boyd, or the Wall Street Journal..  To give the community something to look at while I do the same, a more manageable aggregate list of all the physician and other non-hospital Medicare providers doing business in Louisville or the state of Kentucky is available below.  I have ranked the lists by the amount of money actually paid to individual providers– highest paid providers are at the top. Definitions of the individual items and some other comments about the data are present in the designated tabs.

What Do the Numbers Actually Represent?
There are some caveats attached to the data. It is for calendar year 2012, not the fiscal year often used for these reports. Perhaps the most important limitation is that data are available only for patients in the traditional Medicare Fee-For-Service program. Patients in Medicare Advantage (Medicare Managed Care) are not included. In a community like ours where there is a good bit of managed care, this means we are missing a lot of data. Additionally, the data are not corrected for severity of illness or patient mix in the practices.

The American Medical Association and others who have warned that such data is too complicated for public consumption have a kernel of validity. Without knowing what is behind the numbers, incorrect conclusions can be reached. None-the-less, this data will be extremely valuable. Of course some things will stand out like sore thumbs. This does not mean that something is wrong. Indeed, things that are right will also be found. None-the-less, questions will be raised that deserve to be answered.

First Look– I Quit Too Soon!
I will be examining this data for some time to come. There will be surprises! It looks to me like ambulance services get the most money. Additionally, the medical specialists in Louisville receiving the most money for Medicare patients are not the oncologists, cardiologists, orthopods, or ophthalmologists that I expected to see, but indeed, my old specialty– rheumatology!  In the 1980’s one of my friends wrote an article that showed that rheumatologists were the most underpaid internal medicine specialists. A physician was better off going into general practice and investing the money rather than spending another two years in training at low pay. The result was that for years, the number of residents going on to the sub-specialty of rheumatology fell like a rock.

Be Non-Judgemental- At Least at First.
What has happened in the interim? My guess is that the difference is that rheumatologists now give some of the world’s very most expensive medicines as infusions in their offices. (That is how medical oncologists became highly compensated. Indeed, the rheumatology associations and Arthritis Foundation began to lobby Congress for the same reimbursement privileges as oncologists.) Does this mean that the millions go into the pockets of rheumatologists as personal income?  Not necessarily– there is always the overhead.  How much do the drugs cost, and how much do the physicians have to pay for them? Is the way that insurance companies reimburse for infusions part of the reason that the annual costs of some of the newest bioengineered rheumatology and oncology drugs are so astronomical? Can the temptation to use such drugs improperly become too difficult to resist. What role do the drug companies play?  Is all of this reasonable? In truth, I do not know enough about this matter yet to have an opinion. These drugs came out after I stopped practicing rheumatology. However, I am quite sure that the American College of Rheumatology and related organizations are going to feel pressure to offer explanations! They will be understandable and reasonable– and therefore acceptable to us of the public; or there will be pressure to change something.  I predict that there will be innumerable issues of economics, ethics, equity, quality and fairness that arise from examination of this new information in all areas of medicine. That can only be good.

More to come, including a breakdown by specialty in Louisville. My guess is that primary care physicians may have new data to support what most believe– that they are undervalued for what they do.

What Do You See in the Data?
Please play with the Excel files I make available to you. I make them available for Louisville alone, or for both Louisville and Kentucky. If your are having trouble with the formats, let me know and we can try something else. If you need other help, or have an interesting observation to share, by all means contact me using the link in the side panel of this page.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
April 9, 2014

Note: See subsequent article of April 13 for further background on these Aggregate Databases for KY and Louisville, as well as extracted portions of the Detailed Public Use File that underlies them. (The links below are duplicated in that article.)

Medicare Payments to Providers in Louisville.
Excel file (.xlsx 0.6 MB,  3235 Providers Listed. (Updated April 11)

Medicare Payments to Providers in Kentucky and Louisville.
Excel file  (.xlsx 2.7.MB,   13,205 Providers Listed. (Updated April 11)