Medicare payments to Charlotte doctors can be misleading

04/21/2014 12:20 PM

02/03/2015 4:24 PM

From the reaction I’ve heard to the recent publication of Medicare physician payment data, some readers assumed the worst – that these doctors had committed fraud.

Although some doctors could be gaming the system, it wasn’t meant to be a list of wrongdoers.

It was the first time the federal government published the amounts it reimburses doctors to care for Medicare patients. The payments represented “gross” revenue before expenses, not profits.

Maybe it was the large amounts of money – 15 Charlotte-area doctors received more than $1 million from Medicare in 2012. Or maybe it was the report that the country’s two highest-paid-by-Medicare doctors, including a Florida ophthalmologist who took in more than $26 million, are under federal review for suspected improper billing.

There’s no indication that’s happening in Mecklenburg, where more than 3,000 providers – including doctors, nurses, and physical therapists – received a range of payments from more than $3 million to less than $1,000.

Among the top earners, both locally and nationwide, were ophthalmologists, rheumatologists, oncologists and dermatologists.

Dr. Andrew Laster, a rheumatologist with Arthritis & Osteoporosis Consultants of the Carolinas, said 80 percent of his Medicare reimbursement is for drug infusions that would cost two to three times more at a hospital. Physicians who don’t offer in-office infusions would get lower Medicare reimbursements, but if they refer patients to the hospital, the overall cost to Medicare would be higher, Laster said.

Dr. Andrew Antoszyk, whose $3.75 million payment from Medicare was the most of any Mecklenburg doctor in 2012, said Medicare patients make up more than 70 percent of most ophthalmology practices. He and the other four ophthalmologists who got the highest payments from Mecklenburg are retina specialists whose patients have vision-threatening diseases, such as age-related macular degeneration and diabetic retinopathy.

Those diseases can be treated, but drugs are expensive. Antoszyk said 60 to 70 percent of his Medicare reimbursement is for injections with drugs, such as Lucentis, priced at $1,985 per injection and can be administered as often as once a month. “Are they expensive? Yeah, they’re expensive. But they’ve been a boon to the vision function of our elderly population,” he said.

Medicare reimburses physicians for drugs at 6 percent above the average wholesale price, allowing for overhead and profit. But Antoszyk said the profit ends up at about 1 percent after expenses. The “hidden story,” he said, is that Congress prohibits Medicare from negotiating with drug companies for better prices. “If they could somehow work on that, that would be tremendous,” Antoszyk said.

About Karen Garloch

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@kgarloch

Karen Garloch writes on Health for The Charlotte Observer. Her column appears each Tuesday. Email Karen at kgarloch@charlotteobserver.com or call her at 704-358-5078

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