Should You Get to Know What Medicare Knows?
From an editorial by Chuck Grassley and Ron Wyden:
For no compelling reason, a commanding tool for trying to contain health care costs is lying unused. That sidelined powerhouse is the Medicare claims database, which holds a record of all payments from taxpayers to physicians and other providers for seniors’ health care. If bipartisan legislation now before the Senate becomes law, this information would be made available to all Americans through a free, searchable online database. It would instantly position Americans to secure more value for the $2.7 trillion being spent this year on health services. That’s because the publication of the Medicare data will become health care’s new financial baseline; the measure of what America’s largest and most powerful buyer of health care gets for nearly $600 billion a year. (Politico)
More information is better:
“Markets work best when information is transparent for buyers and suppliers. But in most instances today, patients lack any comparative information and usually don’t find out the cost of their care until after the fact — if at all.”
“By opening the database up to the public, Medicare would serve as the anchor for the health care system. If costs go out of control, Medicare would provide the power needed to reel them back in.”
Yeah but who wields the power of medicare?
It would be a bonanza for the economists and insurance companies.
Do you think it would lower or raise healthcare prices?
You could think about it as giving the little guy the bargaining power of the big guy.
Not exactly, the doctor can still differentiate prices. It would just be more costly.
True.
I’m pretty sure that insurance companies already know what Medicare pays. And a lot of charge data are already available.
See http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html
The power of this database isn’t what Medicare pays. It’s which physicians perform which procedures.
At Medicare prices, of course, which are about to fall thanks to ObamaCare. Will wait times be included?
Since hospital billing is rife with errors, and the prices Medicare pays are “fixed” and therefore don’t provide a consumer with the opportunity to comparison shop — or tell them anything about quality — more data isn’t useful.
“would instantly position Americans to secure more value for the $2.7 trillion being spent this year on health services”
– 2.7 Trillion is a lot of money.
You’re right, it is.
The problem with releasing the doctor’s information without the patient information is that you get an incomplete picture of the physician’s record. Medicare pays the same, regardless of the outcome. A doctor that is incompetent at a particularly risky procedure would tend to not perform that procedure. A doctor that is spectacularly competent would tend to perform more than average. Without knowning the outcomes of the procedures, you cannot grade the competence of the physician, only their acceptance of risk.
In countries with open medical records, such as Iceland, this is not the problem. The cowboy doctors that do too many risky procedures with too many deaths are identified separately from the exceptionally talented doctors that have found their particular niche.
If you release the procedure data without the outcome data, you will unfairly target niche practitioners who are providing a net savings to the system despite their higher income.
If you want to make it open, make it open. I already have life insurance, have never had an abortion, and have never been treated for venerial disease or drug addiction of any kind. I wouldn’t mind anyone reading my medical record. And, as one of the docs that opted out of Medicare, I honestly could care less what anyone thought of what I was billing them, because I’m not billing them anything.
On the other hand, if you actually want doctors to accept Medicare, perhaps you should rethink your idea of a healthcare Brazilian.
I’ve always been uncertain where I fall on this issue. I have a bias because, as a former employee of a 501(c)3 non-profit, my salary was disclosed to the public via IRS Form 990. This is easily available from GuideStar.
Like Dr. Goodman and other writers at this blog, I worked for a non-profit that received no money from the government. It was no business of the public to know my salary, but we submitted to the rule because it allowed us to retain non-taxable status.
The information in the Medicare claims database is a smaller invasion of privacy than the 990: It only contains the physicians’ Medicare claims, not their incomes, which come from multiple sources. And these physicians are earning money from taxpayers directly.
So, it seems to me that there is a good case that taxpayers own this information and it should be made easily available to them.
However, I do not believe that this will lead to lower spending or higher quality, because the government will still fix the fee schedule. Also, choice and competition do not depend on customers knowing how much money people on the other side of the transaction earn. I buy all kinds of things and I neither know nor care how much the various employees of the vendors earn.
So, the benefit (if there is one) would not be to improve cost or quality but to increase physicians’ frustration with Medicare and influence them to demand reforms that get the government out of the fee schedule.