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Monday, Sep 01, 2014

Medicare’s real doctor payment problem


The news that a small percentage of the country’s physicians collected billions of dollars from Medicare in a single year may or may not be a testament to individual greed; some of the top recipients are under investigation for allegedly bilking the system, while others work long hours delivering costly care. But it is a powerful reminder that the program needs to stop rewarding doctors for the quantity of care they deliver rather than the quality. Happily, there’s a bipartisan plan to do just that; unhappily, lawmakers haven’t been able to agree on how to cover its cost. If Congress needed any further incentive to settle its differences, the fact that 1,000 doctors raked in $3 billion from Medicare should provide it.

The Obama administration released details Wednesday on $77 billion worth of payments made in 2012 by Medicare Part B, which pays for doctors and other health-care professionals. Part B is financed mainly by the government, so taxpayers have a keen interest in the program’s financial integrity. More than a dozen physicians each collected more than $10 million from Medicare in 2012, and thousands of specialists in four disciplines — three cancer-related fields and ophthalmology — averaged more than $300,000.

The concentration of payments — a mere 2 percent of the doctors participating in the program took in almost a quarter of the fees — exemplifies the problem with Medicare’s “fee for service” payment system. This system ignores the value and effectiveness of the care provided, paying attention only to how many treatments are rendered. That gives doctors an incentive to provide the most expensive and intensive forms of care, not necessarily the treatments that work best.

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