Giving context to the costs of Medicare

Area health care providers say newly released Medicare payment data doesn’t tell the whole story

WOODSTOCK – Dr. Aslam Zahir runs his Woodstock office like a miniature hospital – complete with nurses, support staff and the tools to administer chemotherapy drugs to treat cancer patients.

But the public, he said, can’t extrapolate those details from newly released government data the Obama administration has hailed as an unprecedented transparency move to spotlight medical services physicians across the country provide and how much they receive in Medicare to do it.

The data from the Centers for Medicare and Medicaid Services show that $77 billion in Medicare payments went to more than 880,000 doctors and other medical providers in 2012 for doctor visits, treatments and tests typically done outside a hospital. Of that total, physicians in McHenry County received more than $45.7 million in Medicare payments.

Like other area medical professionals, Zahir said the massive data release is a “disservice to the public” since it lacks context and potentially could confuse the public on the issue of health care costs.

“There is a discord between what is going on with Medicare payments and what is happening with me,” Zahir said. “Medicare is paying, but the Medicare is paying for drug costs, and the drug costs are rising higher.”

Zahir received $1.68 million in Medicare payments in 2012. Others at his Fox Valley Hematology and Oncology clinic received payments of $1.76 million and $1.55 million.

His office, with locations in Woodstock, McHenry, Huntley, Elgin and Hoffman Estates, ranked near the top in McHenry County with the most Medicare payments. The average Medicare payment for physicians specializing in hematology and oncology was $463,844.

Most of the annual Medicare payments covers drug costs to treat cancer patients directly inside Zahir’s offices. The numbers released by the federal government, he said, make it seem like he is directly profiting off Medicare.

Medicare fraud is one reason why Dow Jones and Co., which owns the Wall Street Journal, sought to overturn an injunction the American Medical Association won in 1979 to prevent the release of doctor-specific Medicare information.

A federal judge in Florida vacated the injunction in 2011, and the victory came with the recent government release of doctor billing data. But physicians like Zahir contend the data has limitations and puts honest physicians in an unfair light.

The data only includes information on Medicare Part B, the fee-for-service reimbursement available to doctors who work outside of hospitals. Certain specialties, such as oncology, rank high because of high drug costs, while some practices bill Medicare charges for multiple physicians under one supervisor.

“I support the fact that providing data is good,” Zahir said. “But providing data in a way that throws out numbers is not the right way to do it.”

Dr. John Michael, an ophthalmologist who runs the Illinois Retina Institute with offices in Crystal Lake and the Chicago area, received $2.1 million in Medicare – the most in the county.

Cliff Jeffers, the institute’s administrator, called the numbers “bogus and not accurate,” since the majority of Medicare payments go toward eye injections to treat patients. He declined further comment.

Ophthalmologists on average received $429,657 in Medicare payments in 2012.

Rescue Eight Paramedic Services, an ambulatory service in Lake in the Hills that transports patients throughout the Midwest, received $1.27 million in Medicare payments. Different doctors in McHenry and Algonquin that specialize in infectious and pulmonary diseases received payments ranging from $762,650 to $652,480.

The wide data set makes it challenging for patients to shop for cheaper health care since it includes information on a variety of physicians spanning different specialties and markets, said Dr. Irfan Hafiz, Centegra Health System vice president of medical affairs.

The lack of context in the data consequently ruins the effort to make Medicare costs transparent to the public, he said.

“I understand the desire for transparency, but sometimes it can create more confusion than it removes,” Hafiz said.