You can now read 10 articles in a month for free on BostonGlobe.com. Read as much as you want anywhere and anytime for just 99¢.

The Boston Globe

Health & wellness

Data

30 Mass. doctors split up $45 million from Medicare

Physicians say payments reflect the costs of drugs

Just 30 Massachusetts physicians — mostly ophthalmologists, oncologists, and dermatologists — were paid more than $45 million in a single year by Medicare, according to detailed new data intended to provide consumers, researchers, and fraud investigators with unprecedented information about the practices of individual doctors.

These 30 doctors received between $1 million and $3.1 million each in 2012 for treating elderly Medicare recipients. The amounts exclude what they were paid by private insurers and other government programs. More than half of these doctors are ophthalmologists, who accounted for less than 2 percent of providers in the state but received nearly 9 percent of the Medicare payments that year.

Continue reading below

Several ophthalmologists said the high payments reflect the steep cost of the brand-name drugs they use to treat age-related vision loss. Medicare generally reimburses physicians for the cost of medications plus pays them a percentage of that price for injecting the drugs.

“The numbers that appear for the retina specialists’ practices are markedly elevated by the cost of drugs we are using to treat blinding eye disease,’’ said Dr. Trexler Topping, president and medical director of Ophthalmic Consultants of Boston, where many of these doctors work. “The numbers make somebody look like a crook when they really are not.’’

Jonathan Blum, principal deputy administrator for Medicare, said in a phone call with journalists Wednesday that for both ophthalmologists and oncologists, “very expensive drug therapies tend to be the treatment of choice’’ and that is not necessarily wrong. But he said it’s important to study the payments more closely.

Medicare officials said it’s important to note that there are legitimate reasons why doctors may get high Medicare payments.

Quote Icon

“What is important for us to understand is how does that treatment of choice vary across the country,’’ he said. “If more dollars are going to one part of the country than to other parts of the country, then that is an important question for us to be asking.’’

Medicare released the physician-payment data Wednesday after a decades-long legal battle. The American Medical Association, a large doctors’ lobbying group, and others fought to stop release of the data, arguing that it would invade physicians’ privacy and mislead consumers. A federal judge in Florida lifted an injunction last year, paving the way for Medicare’s release of the information.

Continue reading below

Blum said that the data has been protected for too long, and that by releasing it, the federal government is partly asking for help in identifying physicians who are providing inappropriate care.

“We know there is waste in the system, we know there is fraud in the system,’’ he said. “We want the public’s help to identify spending that doesn’t make sense.’’

Medicare officials said it’s important to note that there are legitimate reasons why doctors may get high Medicare payments. They could be considered experts in their field, and therefore may treat more patients or the sickest patients, who require more tests and procedures. The data do not provide any information about the quality of care a doctor provides.

“The initial focus will be on those who are outliers,’’ said Dr. Ashish Jha, a professor at the Harvard School of Public Health who often uses Medicare data for his research. But “I don’t know if those people are committing fraud or taking care of a lot of patients.’’

He said he expects health insurers and consumer-oriented companies to use the data to develop detailed physician profiles that describe a doctor’s practice style, such as their frequency of ordering imaging tests and performing expensive procedures.

A Globe analysis of the data shows that Medicare paid 28,600 Massachusetts entities $1.8 billion in 2012. Of that, about $1.5 billion went to doctors and other individual providers such as psychologists and social workers. Only internists brought in more money than ophthalmologists; $276 million went to more than 4,300 doctors who practice internal medicine, must of it for basic office visits and physical exams. Internists, however, were paid far less on an individual basis than specialists.

Six doctors received more than $2 million each in payments, including three ophthalmologists, two oncologists and one urologist.

Dr. Delia Sang, an ophthalmologist who was third-highest on the list, said $1.9 million of her total covered the cost of injectable drugsto treat macular degeneration, while $800,000 was for fees, out of which she paid staff salaries and other office overhead. One of those drugs, Lucentis, is more than six times more costly than a generic alternative of the cancer drug Avastin.

But Sang said clinical studies show patients have better results with Lucentis.

“I have a lot of patients come to me because they have failed treatment elsewhere,’’ she said.
“Most of us will try Avastin first but it does not work for everybody.’’

Since doctors generally receive a percentage of the drug’s price as their fee, they can sometimes earn more by injecting higher-priced drugs. In his practice, which includes the two other ophthalmologists who received more than $2 million, Topping said doctors put most of Medicare’s percentage fee into the practice’s research and education nonprofit organization.

Two oncologists in Western Massachusetts, Dr. Michael DeLeo and Dr. Harvey Zimbler, also received more than $2 million each in payments, but a spokesman said “their actual compensation was significantly lower.’’

“Infusion therapy, which is often a critical component of cancer treatment, can also be very expensive, as the cost of many cancer medications is extraordinarily high,’’ said Michael Leary, a spokesman for Berkshire Health Systems, which the doctors joined last year.

Dr. Evangelos Geraniotis, a urologist on Cape Cod, was paid $2.1 million by Medicare in 2012. “Even though it shows we took in income, we can pay $2,000 for a drug, and the net to us may be $150," he said. “I know the number is a lot, but we are just trying to take care of patients and do a good job with the resources we have.’’

Liz Kowalczyk can be reached at kowalczyk@globe.com.

You have reached the limit of 10 free articles in a month

Stay informed with unlimited access to Boston’s trusted news source.

  • High-quality journalism from the region’s largest newsroom
  • Convenient access across all of your devices
  • Today’s Headlines daily newsletter
  • Subscriber-only access to exclusive offers, events, contests, eBooks, and more
  • Less than 25¢ a week