Vast trove of Medicare data details how billions of dollars are spent

Joint replacement was the most common hospital procedure that Medicare paid for in 2013, accounting for nearly 450,000 inpatient admissions and $6.6 billion in payments.

Among physicians, cancer specialists received the largest payments from Medicare, but much of their reimbursements went to cover the cost of the very expensive drugs to treat their patients.

Those were among thousands of details in a vast trove of Medicare billing data for 2013 released Monday by the Department of Health and Human Services.

Medicare turns 50 next month, and in the age of big data the more than $600 billion that taxpayers spend annually on the program is getting closer scrutiny than ever. Medicare covers 55 million people, a number that keeps growing as baby boomers reach age 65 and sign up. A recent trend of moderating medical spending has not dispelled concerns about the program’s long-term financial stability.

Monday’s data marked the third year the government has released details on hospital spending, and the second year for physician reimbursements.

The information doesn’t include all of Medicare, however, such as spending by popular private health insurance plans offered through Medicare Advantage.

“We shouldn’t draw sweeping conclusions on spending or practice patterns from this dataset,” said Caroline Pearson of Avalere Health, a private firm that analyzes health care costs and trends.

Here are some of the pieces of the big health care puzzle the data do show:

Knees and hips

Nationally, major joint replacement procedures averaged about 12 per 1,000 Medicare beneficiaries. But in some areas of the country, the rate was nearly twice as high or even greater. Health and Human Services said its analysis shows joint replacement surgery rates are highest in the Midwest and Rocky Mountain states.

Such regional variations have long been seen in Medicare data, and they remain a source of debate.

Some experts say they are an indicator of waste in the health care system. Others say they reflect differences in the way medicine is practiced around the country.

Getting top dollar

Medicare spends more total for the services of family practice doctors and adult medicine specialists, the kinds of doctors who follow patients day to day, treating blood pressure problems, high cholesterol and other common conditions.

But on a per-visit basis, specialists command much higher reimbursement.

Health and Human Services says its analysis showed that anesthesiologists, orthopedic surgeons, ophthalmologists and emergency medicine doctors were among the most highly paid specialists.

Data puzzle

Heart disease is the leading cause of death in the U.S., but a cursory look at Medicare’s hospital billing files doesn’t reflect that.

That’s partly because heart conditions can be billed under many different payment codes.

For example, there are two major codes for heart failure, depending on the severity of the case. Heart failure is a progressive disease, as the heart gradually loses its ability to adequately pump blood through the body. The two major heart failure billing codes accounted for more than 390,000 hospital admissions in 2013.

Analysts must factor in bypass surgery, arrhythmias and other conditions for the full burden of heart disease to become clearer.

‘Medicare millionaires’

Medicare paid at least 3,900 individual health-care providers at least $1 million in 2013, according to a Bloomberg analysis of the data, and five received more than $10 million each.

Last year, some doctors complained that the data created a misleading impression about their practices, because their total reimbursement included medication costs. An oncologist, for example, might routinely and properly prescribe expensive chemotherapy drugs and show up for hundreds or thousands of dollars, or even millions, in reimbursement, when nearly all the money went directly to cover the cost of the drugs.

Health and Human Services noted this year that drug costs account for a large portion of reimbursements for cancer doctors, ophthalmologists, rheumatologists and doctors who treat blood disorders, so high totals for such practices don’t necessarily mean the physicians themselves are getting much of that money.

This story was originally published June 1, 2015 at 9:48 PM with the headline "Vast trove of Medicare data details how billions of dollars are spent."