The Medicare Physician Payment “Data Dump”: Don’t Stop Now
In April, the Centers for Medicare & Medicaid Services (CMS) dumped a treasure trove of raw data into the public domain: The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File.
Resisted for years by organized medicine, this release publicizes a dataset of Medicare payments to doctors by name. The data released are for 2012; and CMS plans to release more data in the future.
The New York Times was well prepared for the data dump, and has an easily navigable website where subscribers can enter any doctor’s name and find out how much he earned from Medicare in 2012. Doctors whose Medicare revenue was in the millions found TV cameras at their offices the next morning, and had microphones stuck in front of their faces. The data continue to be analyzed, with interesting results: ProPublica has concluded that 1,800 providers billed the most expensive rate for any given procedure at least 90 percent of the time, although those rates are only for the most complex cases.
Needless to say, organized medicine is freaking out. The American Medical Association (AMA) has written an open letter to CMS complaining that “untrained observers nonetheless are using the data to make flawed regional, specialty, or other comparisons that CMS should do more to discourage”. Instead, the AMA would like the government “to develop and refine a more selective data set…”
The opposite is called for. Instead of AMA-guided censorship of the data, more should be released. The AMA complains that the dataset is missing many thousands of billing codes. Okay: Bring on the other datasets.
Nor does the AMA discuss its own responsibility for the potentially confusing and misleading claims data. Physicians’ claims come from billing codes created by the AMA. Creating and licensing these codes is the AMA’s primary line of business. If it does not want the public to know how much each doctor is earning through this system, the easiest solution would be to get the government out of the business of paying claims according to a fee schedule, and give each Medicare beneficiary a type of voucher to buy a private Medicare plan (somewhat along the lines of today’s Medicare Advantage plans).
The current claims data are the taxpayers’ property. Once released to the public, anyone can analyze and present it as they prefer. Similarly, every weather service uses the same (taxpayer-funded) data from that National Oceanic and Atmospheric Administration’s satellites, stations, and buoys. There is nothing preventing the AMA from setting up a website, like the New York Times has, presenting this data in a way that it believes serves the public interest.
The Obama Administration has done very little that is positive in health care. Its commitment to releasing data that shows us who earns the money that taxpayers spend on Medicare is to be congratulated.
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“untrained observers nonetheless are using the data to make flawed regional, specialty, or other comparisons that CMS should do more to discourage”.
This is the classic argument of outrage. Less transparency makes them nervous. The reason the public are “untrained observers” is because the numbers that are in data are likely high for some physicians. It will come off as gratuitous to the public, as well as it should.
“Doctors whose Medicare revenue was in the millions found TV cameras at their offices the next morning, and had microphones stuck in front of their faces.”
Is there anything better than when people who take advantage and profit greatly from a program are ousted for doing such? I love seeing this and see the excuses and backpedaling.
Making an issue transparent to the public is always a good way of changing policies.
To which the physicians response is, “don’t hate the player, hate the game.”
Well that is definitely the tl:dr version of it.
“The AMA complains that the dataset is missing many thousands of billing codes. Okay: Bring on the other datasets.”
Yes lets dig the hole even deeper.
“Nor does the AMA discuss its own responsibility for the potentially confusing and misleading claims data. Physicians’ claims come from billing codes created by the AMA.”
I feel they already have.
“The Obama Administration has done very little that is positive in health care. Its commitment to releasing data that shows us who earns the money that taxpayers spend on Medicare is to be congratulated.”
I can wholeheartedly agree with this statement.
I know it’s inconvenient, but authors and blogs really should be more honest in their portrayal of the AMA – it is an organization funded by their CPT monopoly that has a membership representing about 15% of physicians many of whom are retired or residents. Doctors have abandoned the AMA, there is no organized medicine. The AMA does not represent doctors nor their views. Again, it’s inconvenient not to have one label to pin on doctor’s political thoughts and action, but none exists and certainly that label is not AMA.
Thank you. I think this blog does a pretty good job of describing how the AMA is behind the coding mess. In previous articles I have written more thoroughly about the AMA’s business, even analyzing its financial statements.
1,800 providers billed the most expensive rate for any given procedure at least 90 percent of the time
It sort of makes you wonder where the Office of Inspector General was during the past 20 years? Patients tend to fall into a bell-curved distribution. Anything that deviates from that is suspect.
Unless you are practicing medicine it is impossible to know the ridiculous administrative burden placed on physicians by Medicare, Medicaid, and private insurers.
Most of the above comments focus on one or two issues among many.
Bottom line, I have taken a 77 percent cut in Medicare rates since 1990. Collections are 30 percent of 1990 chasrges. Overhead has exploded due to staff requirements to verify insurance and obtain authorizations for much of what I do.
The best strategy for financial survival will be to drop all insurance plans and post and charge fair prices for saving your life.
Thank you. That is a great idea. Unfortunately, the ratio of physicians who actually do it versus those who talk about it is vanishing small.