LEWISTON — A local doctor billed Medicare for more than $2.3 million in 2012 for work that, at first look, appeared to include giving 110,000 shots.
Rheumatologist Robert Sylvester was the highest Medicare-paid doctor in Maine that year, according to data released Wednesday that detail payments made to more than 880,000 practitioners across the country.
NorDx clinical laboratory in Scarborough was the highest-paid medical office in the state at nearly $4 million.
In a noon conference call with reporters, officials from the Centers for Medicare and Medicaid Services said the reasons for the “unprecedented release” were threefold:
* To show much the Medicare program was spending and what it was spent on;
* To help researchers and doctors figure out why spending varies around the country;
* And to put the public to work spotting fraud.
“We know that there’s waste in the system,” CMS Principal Deputy Administrator Jonathan Blum said. “We want the public’s help. We want reporters’ help to identify spending that doesn’t make sense, that appears to be wasteful, that appears to be fraudulent.”
The release Wednesday included 10 million lines of data on 6,000 services performed by 880,000 practitioners at a cost of $77 billion.
Gordon Smith, executive vice president of the Maine Medical Association, said he didn’t oppose the release but wished doctors had been given a chance to confirm the numbers and that they’d been delivered with context.
“You see Medicare patients, this is what you bill, this is what you get paid,” Smith said. “People need to understand, it isn’t your net.”
In Sylvester’s case, it also wasn’t 110,000 shots despite lines of data that read, “Tocilizumab injection, number performed: 62,920.”
Reuben Allen, Sylvester’s business adviser, said the injected biologic drugs are billed in units.
“That is not times performed, but it’s the units that he gave the patients,” Allen said.
For example, Abatacept is infused every four weeks, up to 40 units at a time. Infliximab is given every four to eight weeks at 50 to 150 units per infusion.
Sylvester, in practice for almost 40 years, has an office on the Central Maine Medical Center campus but maintains a private practice with hospital privileges.
“He starts work at 7:30 in the morning and sees patients until 5 or 5:30 at night. That doesn’t happen often,” Allen said. “The average rheumatologist will see somewhere around 20 patients a day. He’ll see 30, 35 patients a day because he’s working a longer day.”
Dr. Sirus Hamzavi, an ophthalmologist and the second-highest Medicare-paid doctor in Lewiston behind Sylvester with $1.2 million, said it was “easy to get the wrong impression” from the data.
“Unfortunately, it seems like from the data that rheumatologists and ophthalmologists are getting the most reimbursement because we use, unfortunately, or fortunately, as the case may be — it’s fortunate for you if these drugs are helpful for you — we use these very expensive medicines,” Hamzavi said.
Doctors are paid for the cost of the drug, plus handling, with Medicare setting the rates.
“Because the health care economy is such a big part of what’s happening in our country, I think greater transparency is good,” Hamzavi said. “But I think it’s unfortunate the way this data was released. Someone who doesn’t take the time to critically look at it won’t understand that a large part of the quote-unquote ‘payment’ from Medicare is actually reimbursement.”
Only one physician among the top 10 highest-paid by Medicare in Lewiston, rheumatologist Dr. Lee Kendell, is currently employed by a local hospital, CMMC. Urologist Dr. Joel Olstein worked for St. Mary’s for two months in 2012 and retired a few months later, a spokesman there said.
The release includes an almost-dizzying amount of data. According to Centers for Medicare & Medicaid Services, Central Maine Magnetic Imaging Associates performed 285 brain MRIs without dye at an average payment of $244.55 each. United Ambulance logged 9,886 miles carrying Medicare patients. Hamzavi performed 56 new patient eye exams.
Emily Brostek, consumer assistance program manager at Consumers for Affordable Health Care, said the data release had been blocked by interest groups for some time.
“So I’m glad to see this is out there so consumers can know how much services cost,” she said. “It is a lot of raw data right now. It’s nice that consumers can jump into the data directly, but I’m sure there will be lots of analysis in the next weeks and months and even years (ahead).”
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