Leana Wen, the new health commissioner of Baltimore, Maryland gave an instructive TED talk entitled “Who Is My Doctor,” and has famously said, I believe that medicine has maintained its mystique for far too long, and it’s time to open the veil of secrecy and have patients and providers alike participate as equal partners. I believe that patients have to be part of every discussion that takes place in healthcare, from research to system design to medical care.
Physicians need to recognize that we are here to serve the sick. The practice of medicine should not be a means to enrich one’s self at the expense of patients, their insurers of Big PhARMA. Unfortunately, many physicians are entrepreneurs who have learned to game the system. Two of the most common ways to do this are by performing unnecessary tests or procedures and by climbing in bed with Big PhARMA.
Recently, the New York Times had an article about unnecessary cardiac procedures and revealed that a Florida cardiologist was paid $18 million by Medicare in 2012, making him the top-billing cardiologist in the country. Over-diagnosis and over-treatment are not problems unique to cardiologists. Many primary care physicians and diverse specialists have figured out how to game the system at the expense of patients or providers.
Over-diagnosis and over-treatment allow many physicians to make considerable sums from unnecessary tests and procedures. Actinic keratoses are a source of income for many dermatologists; in addition, innocuous skin cancers are often over-treated by unscrupulous or ignorant providers.
We looked at the billing practices of the six dermatologists in a county of a New England state. All served a similar population of patients. The table shows that in 2012 one practitioner billed Medicare for 20,004 cryosurgeries compared to 214 of these procedures by another dermatologist. The highest billing dermatologist in this group collected $940,000 from Medicare for this subset of patients alone. Medicare is only one insurer for these doctors’ patients.
Bedding Down With Big Pharma is another way that physicians supplement their income. Some physicians make a tidy sum from giving talks for pharmaceutical firms. This often takes place at so-called CME meetings. Two websites are helpful for tracking these physicians: Dollars for Docs and Open Payments. Not all companies participate with this reporting.
As an example, I am aware that in my specialty, dermatology, there are a number of doctors who make over $100,000 a year from Big Pharma (and this is in addition to their regular income from teaching and patient care). One New York dermatologist was paid $93,000 just for talks given to other dermatologists in 2013. These, so-called “key opinion- or thought- leaders” push expensive new medications when older, much cheaper medications would be appropriate. You can look up your doctor at Dollars for Docs or Open Payments.
The akamai patient can research her or his physician at the websites provided below. These are not perfect resources but they are helpful places to start.
So, perhaps it is time for you to ask, “Who Is My Doctor” and to check up on your favorite providers.
Resources:
1. Medicare payments to U.S. physicians: Use this form to find a doctor or other medical professional among the more than 800,000 health care providers that received payments in 2012 from Medicare Part B, which covers doctor visits, tests and other treatments.
2. Dollars for Docs (Propublica): In recent years, drug companies have started releasing details of the payments they make to doctors and other health professionals for promotional talks, research and consulting. As of 2013, 17 companies published the information, most because of legal settlements. Use this tool to search for payments.
3. Open Payments is a federal program that annually collects and makes information public about financial relationships between the health care industry, physicians, and teaching hospitals. The Centers for Medicare & Medicaid Services (CMS) collects information from manufacturers of drugs and devices about payments and other transfers of value they make to physicians and teaching hospitals. These payments and other transfers of value can be for many purposes, like research, consulting, travel, and gifts. CMS will be making this data publicly available each reporting year.