Wednesday, September 3, 2014

While others have dispassionately made the point that there are unexplained variations in Medicare physician billing data that warrant careful consideration when using such data, one doctor thinks CMS has devious motives.  He says, "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." I summarize without comment, but I welcome your reactions.

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: 

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.


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