On
April 9, the Centers for Medicare and Medicaid Services (CMS) released
data on Medicare reimbursements made to individual health-care providers
in 2012. The government claims that
this was done for the sake of transparency, to reduce fraud, and to
encourage Americans to seek high-value healthcare. Call me paranoid, but
I cannot help but wonder if there might be something more here.
If
the goal of releasing these data is truly to increase transparency,
reduce waste, and help market forces to improve the efficiency of
health-care delivery in this country, the data have to be complete and
accurate. This, however, may not be the case. For example, if Medicare
services provided by a number of health-care professionals are billed
under a single provider, which may be the case in certain programs
and/or clinics, that individual will have these services wrongly
attributed to them. In cases where the individual physician did actually
provide the services, the data do not account for differences in case
mix, as some providers really do see sicker patients than others. To
this end, these physicians may get reimbursed to a greater degree, but
these larger amounts may be entirely appropriate. Finally, there are
going to be cases where the data are just simply wrong.
It is worth
noting that, in reviewing the “frequently asked questions” page on CMS's
website, I was unable to find a link for physicians to
question the accuracy of their data. However, I do not think CMS is
concerned with my opinions on these data.
So, if CMS is
not interested in the physician's concerns about the accuracy or
validity of the data, what are they concerned with? Certainly, I believe
that there is likely some truth to their statements around increasing
transparency, eliminating waste and fraud, and trying to empower
patients to select high-value healthcare. That being said, I believe
there is a hidden agenda here. The Medicare physician reimbursement data
were released just weeks after the passage of yet another temporary
legislative patch for the sustained growth rate (SGR) cuts to providers.
The SGR cuts are always the focus of physician lobbying efforts and,
ultimately, politicians are well aware of the negative fallout that
would occur if these cuts actually went through. By showing the public
just how much Medicare currently pays physicians, it may lessen the
political fallout of letting the SGR cuts go through.
In
addition, immediately after the release of the data, the media ran a
number of stories showing how some of the highest Medicare billers were
also some of the largest political donors in the United States. Was
either of these events a coincidence? I do not know, but I doubt it. I
believe that the release of these data by CMS was an attempt by
policymakers to sway public opinion against physicians and lessen our
political power in Washington. Ultimately, the clinicians must be the
ones at the table informing the discussion on the effectiveness of
treatments and defending our patients' right to access to these
therapies. If policymakers can turn the public against physicians and
neutralize the voice of organized medicine on Capital Hill, it will be
easier for them make unilateral changes to the Medicare program in the
United States that may lessen costs but may also end up hurting
patients.
I suppose the good news is that the modern news
cycle seems to get shorter and shorter and the media has already moved
on from this story. That being said, the government will release data on
physician payments from pharmaceutical and device companies this fall. I
am certain physicians again will be the focus of negative publicity
when this occurs. Ironically, Congress will be considering another SGR
fix at precisely the same time. Coincidence? I think not.
David F. Penson, Department
of Urologic Surgery, Vanderbilt Center for Surgical Quality and
Outcomes Research, at Vanderbilt University Medical Center, published an article in the journal Urology, called
"The Hidden Agenda in the Release of the Medicare Physician Reimbursement Data." (Volume 84, Issue
3, Pages 501–502, September 2014.) Excerpts: 
5 comments:
I think the Dr. Penson is a bit cynical. I think issues like multiple providers in a clinic billing under one provider number and ophthalmologists prescribing Lucentis for macular degeneration at $2,000 per dose on which they make only a small profit margin among other issues can skew the data. It shouldn’t be all that hard to create a tool for doctors to either correct or amplify the data so people using it have a better understanding and appreciation of the doctors’ perspective. Given the massive technology failures associated with the rollout of Healthcare.gov, the problem here is more likely attributable to bureaucratic rigidity and incompetence.
At the same time, the consensus is that there is plenty of fraud in both the Medicare and Medicaid programs and the release of this data is, on balance, helpful in my view. As I understand it, fraud is especially prevalent in areas like post-acute care including physical therapy and home healthcare. We need to try to shed as much light on this as possible.
I am always amused by people who impute lack-of-coincidence or conspiracy motives to our federal government. (And they are not always Republicans.) If they have ever worked for it or closely with it, they would realize that, other than the NSA and such agencies, the government simply is far too inefficient for such theories to hold water. The left hand can hardly even see the right hand, much less coordinate with it.
I ask, why shouldn't Medicare make these payments public knowledge? The taxpayers are funding those payments. Conspiracy or not (and I would agree that Medicare is probably just about as efficient as the entire healthcare system in executing on conspiracies), the public has a right to know how its dollars are spent, whether on doctor payments, executive salaries (and I am a doctor executive), and other sectors of the system.
-- Joanne Roberts, Everett WA
Please sign our petition to have Medicare cover hearing aids under HR 3150. http://petitions.moveon.org/sign/to-pass-hr-3150.fb73?source=c.fb&r_by=6379786
Please repost to all social media and write your Congressmember. We need this to go viral so Congress hears our voices.
Janice Schacter Lintz, Chair, Hearing Access Program
I tend to agree with him. The trend is to have physician services become a commodity in order to drive reimbursement down. What better way to suggest that there is room for price control by revealing individual physician reimbursements, regardless of accuracy, in order to set the perception. Another example is the dilution of the role of a general surgeon. More and more positions are "procedure" focused as hospitals only want the technical component provided by the surgeon.
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