Colorado Springs News, Sports & Business

Top 2% of Colorado Springs clinicians bring in 25% of Medicare reimbursements

By Jakob Rodgers Updated: April 10, 2014 at 9:46 pm

Eye doctors, oncologists and outpatient surgical centers reaped some of the largest Medicare reimbursements across Colorado Springs in 2012, according to a survey of physicians' medical bills released this week.

Mirroring national trends, the top two percent of Colorado Springs clinicians and providers brought in a quarter of Medicare's reimbursements in 2012, according to Gazette analysis of data released this week from the Centers for Medicare and Medicaid Services.

Together, those 27 clinicians' and providers' reimbursements averaged $1,056,124, far above the city's overall average reimbursement of roughly $81,500.

The database offers a first-of-its-kind look at $77.4 million in Medicare Part B reimbursements to more than 880,000 health care providers - a trove surpassing what major insurance companies have on file. In short, it's a doctor-by-doctor tool that could be used to spot fraud or excesses in health care spending.

Although Medicare is financed by taxpayers, the data have been off-limits to the public for decades - held up in litigation by physician organizations that argued it would amount to an invasion of doctors' privacy.

But observers and clinicians across the nation also voiced caution - painting the database as little but raw data in dire need of context and perspective.

In particular, reimbursement rates to ophthalmologists and oncologists came as little surprise to Mike Ware, the El Paso County Medical Society's executive vice president.

"A lot of what's driving the increase in the spending of these two specialties is because of the drugs they have to purchase to treat their patients," Ware said.

Two Colorado Springs ambulatory surgical centers received the highest reimbursements, totalling nearly $6.7 million. Nine doctors specializing in the treatment of cancer also ranked among the top 2 percent.

Four retinal specialists in the same practice - Retina Consultants of Southern Colorado, PC - received nearly $5.3 million in Medicare payments, the most of any four ophthalmologists in the city, the data showed.

Dr. Ryan Rich, one of the clinicians, attributed the sum to the high cost of powerful drugs, such as injections for wet macular degeneration. The condition can cause blindness if left untreated with monthly shots that can cost up to $2,000 each.

In addition, the practice is the only retinal center in southern Colorado - making it a destination for the elderly, because they're the most likely to suffer from costly eye conditions, he said.

"That's our concern about these numbers that were published: They're completely untransparent because they don't tell the whole story," Ryan said. "We're all for transparency, but we're for complete transparency."

When asked how much of Rich's nearly $1.5 million reimbursement went toward salary, he declined to offer specifics late Thursday night. But he noted that more than 80 percent went toward drugs and overhead costs.

The data has limits, said Adam Atherly, associate professor with the University of Colorado School of Public Health. The data offers no insight into the quality of care provided, he said. And compounding concerns are the fact that some reimbursement figures may include treatments that were administered by many physicians but billed under one name.

"Terribly useful data, and I'm thrilled it's out in the public domain," Atherly said. "But I don't think it should be used for witch hunts right away."

-The Associated Press contributed to this report

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