It took more than a decade of full-time training after medical school for Dr. Gohar Salam to be able to perform the complex eye surgeries he specializes in at his private practice on Diebold Road.
A retinal specialist in ophthalmology, Salam is not in the yellow pages, gets most patients through referrals and can operate on the delicate tissues inside the eye using lasers and other high-tech equipment.
He also treats ailments such as macular degeneration, which can lead to loss of vision and can also require regular injections of drugs to treat properly.
Medicare covers these drugs in about 80 percent of his patients, Salam says, which means a recent data dump by the government showing Medicare payments to doctors all over the nation may make him look like a king compared with other doctors in the area.
But he and other area doctors say those numbers don’t tell the whole story, especially when they are paying for their own drug supplies as well as overhead on buildings and staffing.
The biggest trouble with releasing the raw number is it’s misleading, Salam said. People need to be educated.
The data, released by the government this month, shows how $77 billion was paid out through Medicare Part B to roughly 880,000 doctors and health care providers for more than 6,000 procedures during 2012.
The release came after the lifting of a 35-year-old court-issued gag order that prevented anyone revealing those payments.
In 2012, Salam received $2.3 million from Medicare, the most of any other individual physician in the city and one of six in Fort Wayne to top the $1 million mark.
All of that money, though, does not go into his pocket to take home, Salam said.
The notion someone is getting rich is a lie, he said.
And that’s been the opinion of many other doctors across the country and locally about the release of the data.
To give an idea of how expensive the drugs are that Salam buys, he showed The Journal Gazette invoices detailing $809,470 worth of purchases during the first three months of this year alone.
He said he pays roughly $500,000 a year in rent and the machines he uses in his office are another $700,000.
It’s the 20 percent of his patients who are private patients who are paying for his salary and his 14-member staff, he said.
When you see that total, that’s not all the doctor’s take-home pay, said Dr. John Crawford, an at-large city councilman and oncologist.
Crawford received nearly $76,000 in Medicare payments, according to the government data.
The only problem is you don’t know what that number means, he said when talking about total payments.
I work with a lot of oncologists and some of the medication they give is very expensive, Crawford continued. In their office, they may have paid $500 from the manufacturer and maybe charged $525.
Doctors in ophthalmology, like Salam, were found to be among those receiving the highest amounts of payments, according to published reports.
In Fort Wayne, two of the top five doctors and health care providers in Medicare payments were in ophthalmology.
The seven top doctors in the Nashville, Tenn., area were also in ophthalmology, according to the newspaper The Tennessean.
According to Salam, doctors in his specialty are dealing with newer drugs, some of which can cost upwards of thousands of dollars.
As recent as a decade ago, he said, there was no real way to treat macular degeneration.
Now, doctors can give shots to patients that treat the disease, which is usually found in older people.
Some of the cheaper shots need to be administered once every four weeks and can cost as little as $60, Salam said.
According to him – and data analyzed by the New York Times backs this up – Salam uses this medication most often.
A newer and more expensive medication, which costs about $2,000 a treatment but requires one shot every eight weeks, is available and has been used by Salam.
But he only uses that shot when he feels the patient will benefit from a less rigorous medication schedule or if the other drug is not effective in treating a patient, he said.
The New York Times data analysis breaks down procedures and drugs administered by each doctor.
Salam, though, says that is still flawed, because it does not take into account how doses of drugs are to be reported by the drug companies.
For instance, the data show that Salam injected a drug called Ranibizumab 240 times in 2012.
However, one injection is supposed to be reported as having used five units of the drug, he said.
Thus, he only did 48 injections, he said, though it shows up as 240.
Others said the government information can be misconstrued because it does not take into account that some doctors treat terminally ill patients.
Many of these patients need complex care.
Some doctors are taking care of some really tough patients, said Dr. Stephen Tharp, a past president of the Indiana Medical Society and a practitioner of internal medicine in Franklin.
Tharp added that many doctors he talked to are not upset about the release of the data, but simply feel it won’t answer the questions people want answered.
He also expects more to be released in the future.
Honestly, I believe the government is going to send out some quality information, he said.
While we have some serious concerns about how they gather that quality info, quality is very important.