The federal government released an enormous amount of information Wednesday on how much Medicare paid more than 880,000 providers in 2012, including details about several thousand South Carolina doctors.
Medicare published data on more than 880,000 providers across the country on Wednesday.
Dr. Pat Cawley, vice president for clinical operations for Medical University Hospital, said the data should be interpreted carefully - and some of it may be incorrect.
For example, he said the amount an oncologist is paid by Medicare should not be interpreted as take-home profit. Some of the money must be used to pay for chemotherapy drugs that the practice administers to its patients, he said.
Here is a snapshot of some of the South Carolina providers in the new Medicare report. The following doctors earned more money from Medicare than any other doctors in this state in 2012:
Number of Medicare patients: 1903
Total provider services: 315,833
Submitted charges: $6.52 million
Amount Medicare paid provider: $3.22 million
Number of Medicare patients: 1740
Total provider services: 71,775
Submitted charges: $8.36 million
Amount Medicare paid provider: $3.19 million
Number of Medicare patients: 1346
Total provider services: 352,311
Submitted charges: $6.03 million
Amount Medicare paid provider: $2.93 million
Number of Medicare patient: 1246
Total provider services: 275,851
Submitted charges: $6.34 million
Amount Medicare paid provider: $2.89 million
Number of Medicare patients: 1243
Total provider services: 343,397
Submitted charges: $5.7 million
Amount Medicare paid provider: $2.8 million
Source: Centers for Medicare & Medicaid Services
It's been widely considered a watershed effort to improve health care transparency, but how useful all this new data will be for the average patient remains unclear.
"I'm not sure at this early stage if it's helpful yet," said Dr. Pat Cawley, vice president for clinical operations at the Medical University Hospital. "I think what's missing is how to interpret the data."
The Centers for Medicare & Medicaid Services (CMS) published these huge data sets early Wednesday, despite long-standing opposition from the American Medical Association, which did not want the information made public because it feared the release could generate "inaccuracies, misinterpretations and false conclusions."
While CMS said the data may not be representative of a physician's entire practice - the spreadsheets only include information for the Medicare Part B program - and it is not intended to indicate the quality of care a doctor provides, it is comprehensive and, for the first time, public.
For example, it's now possible to know how many doctors treated Medicare Part B patients in South Carolina in 2012, which services the providers billed the government for and how much they were paid for those services. It's also relatively simple to find out which doctors were paid the most by Medicare.
But the data isn't user-friendly. The master file is too large to open in Microsoft Excel. It's not flawless, either. Cawley said he searched for his own name and found that the government listed his specialty incorrectly.
"The advantage of all this transparency is there will be a lot more eyes on the data," he said. "This is the first generation. The tools will get better in the next couple of years. That's what I'm going to assume will happen."
The Health Data Consortium, in collaboration with the federal government, launched a $20,000 contest called Code-a-Palooza. The competition is intended to encourage programmers to create digital tools that will make all this raw Medicare data more useful for patients.
In the meantime, health care experts agree the data probably raises more questions than it provides answers.
For example, the data shows that four of the top five South Carolina doctors who received the most Medicare money in 2012 work for a group called Coastal Cancer Center in Myrtle Beach.
The reason may be simply explained because more retirees live in Myrtle Beach than in other parts of the state, so the Coastal Cancer Center treats more Medicare patients. Also, hematology and oncology services cost more to deliver than many other specialities. Other reasons could be less apparent. The practice did not return a message left Wednesday.
In another case, the spreadsheets show that Dr. Larry Smith, a pediatrician in West Columbia, billed Medicare $10.7 million in 2012, more money than any other single doctor in the state. The actual amount he was paid by Medicare was much less - about $2.8 million.
Smith was not available to discuss the data on Wednesday, but Matt Havens, the director of operations for Palmetto Infusion Services, where Smith works, said the doctor oversees infusions for patients with chronic conditions.
While Smith is a licensed pediatrician, his scope of practice includes mainly Medicare patients, Havens said.
Dr. Radwan Hallaba, a local physician and owner of Medcare Urgent Care, said this new Medicare data is useful, but the information should not be used to draw hard conclusions about how doctors do business.
"You've got all kinds of different drivers feeding this health care industry," Hallaba said.
Medcare Urgent Care publishes prices for some of its services online. Like the new Medicare physician data, it's another example of the broader push for improved health care transparency.
"Any kind of step to shed light on some of the discrepancies and differences across the different markets has the opportunity to be useful," Hallaba said.
The South Carolina Medicaid agency, which provides health insurance for about 1 million low-income adults and children, is expected to publish the prices that Medicaid pays for several common hospital procedures on a new transparency website later this month.
Reach Lauren Sausser at 937-5598.
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