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Editorial: Medicare transparency is an eye-opener

The Centers for Medicare and Medicaid Services released information on payments to 880,000 medical providers last week. This is information that should be public.

This has not always been the case in the past.

“When I was prosecuting Medicare fraud cases years ago, it was often difficult even for us as prosecutors to get Medicare data in a timely fashion,” Jay Darden, a partner at Patton Boggs in Washington, told Bloomberg News. “So the notion that now it’s not only being released, but released to the public, that could very well signal a recognition from CMS that it’s had a problem in the past and it needs to do something about it.”

But along with the right to public information comes the responsibility to put the information in perspective. Ophthalmologists and oncologists topped the list of doctors paid by Medicare. That makes sense given the eye and cancer problems suffered by many of the elderly people covered by Medicare.

Ophthalmologist Dr. Craig Morgan of Huntington was the state’s top physician provider, receiving just under $5 million in 2012. Second on the list was radiation oncologist Dr. Joseph Baisden of Princeton at $2 million.

This makes sense.

Macular degeneration is a major cause of the loss of vision among the elderly because of damage to the retina. People lose the ability to read or recognize faces. This affects their independence as well as the quality of their life.

Of course sufferers should visit an ophthalmologist, and treatment is expensive. The Food and Drug Administration approved injecting Lucentis into the eyeball. Each dose is $2,000. Medicare paid Dr. Morgan $3.7 million for these treatments alone in 2012.

Likewise, using radiation to treat cancer is effective but expensive, which explains why Medicare paid Dr. Baisden $2 million.

“General ophthalmologists are not performing these types of injections normally, so their Medicare reimbursement is going to be different,” Morgan told the Gazette’s Lydia Nuzum. “As a retina specialist, I know that these injections are in such high demand, and that we perform a great number of these injections because of that.”

Yes, there is fraud in Medicare, and this new transparency could help reduce it. But what really drives up the cost of Medicare is age. As people live longer, their health problems become more common and more expensive.

Credit is due to the Obama administration for making this information public. The transparency could help save money in the long run and improve the public’s understanding of the high cost of the Medicare program. Meanwhile, the public needs to be very careful in its interpretation of complex medical data to be able to make informed judgments about the spending.


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