Ophthalmologists, the greatest beneficiaries of Medicare payments, would like to explain why they were reimbursed millions of dollars. Wednesday's historic data release of doctor payments showed that 17,000 eye doctors received 7 percent — or $5.6 billion — of all Medicare payments in 2012, including one doctor who received $20 million. But in interviews with The New York Times, those doctors explained that expensive drugs and a high percentage of older patients are the main reasons their billings are so high. 

One reason eye doctors dominate the highest paid Medicare doctors (half of the 100 highest paid physicians were ophthalmologists) is their patients tend to be older. “You would expect ophthalmology to be heavily represented in a payment system that is for age 65 and up,” Dr. Michael X. Repka, medical director for governmental affairs at the American Academy of Ophthalmology, told The Times

But it's really the medications and injections that drive their rates up. Doctors perform thousands of injections a year, and one major contributor to eye doctor payments is Lucentis, a $2,000-per-dose shot used to treat macular degeneration (which, untreated, can lead to blindness). There's been a controversy over whether doctors shouldn't be using Avastin, which costs $50. But as we explained in January, Genentech, the drug's manufacturer, doesn't offer Avastin in the right packaging and the Medicare agency can't negotiate better prices. Doctors make as much as 6 percent on the cost of the drug — which is also controversial — but most of the $2,000 goes to Genentech. “I don’t control what Medicare decides to pay the drug company,” John C. Welch, a Nebraska eye doctor, told The Washington Post — he said he makes less than 3 percent on the cost of the drug. In 2012, Genentech received $1 billion for Lucentis.

It's not just eye doctors who are pointing to high drug costs. The Washington Post spoke with a rheumatologist, Gerald Ho, who was paid $5.4 million in 2012. Ho said "probably about" $5 million went towards drugs to treat rheumatoid arthritis, and the rest goes to pay him and his staff of 40. “People are going to see these numbers and people aren’t going to understand,” he said. “I am not pocketing $5.3 million ... I understand the government wants to provide a measure of transparency. But when they throw out numbers like this without any context, it’s going to be misconstrued by the public.” That's a fair point, but data is more likely to be misconstrued by the public when physician groups spend decades keeping the information private.