medicare data


Counterpoint: Medicare Data Flood Useful, Just Not To Average Patient Yet

Source: Dr. Farzad Mostashari, Engelberg Center for Health Care Reform, The Brookings Institution

Source: Dr. Farzad Mostashari, Engelberg Center for Health Care Reform, The Brookings Institution

For a moment there, it looked like a point-counterpoint clash of health-policy views, based on this post: Deluge of Medicare data: Is it useful? Well it’s a step.

Dr. Darshak Sanghavi, a distinguished Massachusetts-based doctor/author who is now a fellow at the Engelberg Center for Health Care Reform at the Brookings Institution, tweeted that he was “not on board with that view.” (The view that the great recent gush of Medicare data is not very useful. At this point, anyway.)

Turns out, though, that Dr. Sanghavi is quite willing to stipulate that, as he put it when we spoke today, “It is highly unlikely that the average patient can do much with Excel spreadsheets containing millions of line items with medical codes.” So from the patient’s point of view — our usual CommonHealth vantage point — he agrees.

But he adds a big “however.”

“However, having said that, I think part of the challenge now is: What should people who have data-crunching skills — whether private industry, regulators, government officials and others — now that the data is out there, what business case can be made for them to do that work for you?”

“I think the key consumer here is not the patient — tens of millions of spreadsheet entries are not going to be valuable to patients. But this is exceedingly valuable to insurers now. Insurers know what their claims are now, but there’s a very competitive insurance marketplace. As an insurer you only know, say, your 5 or 10 percent of the market, but now that you have Medicare data, you can say, ‘That’s really weird. On Medicare patients, they’re only doing steroid injections on one patient out of 10 or whatever, whereas on my covered patients, they’re doing it on 50 percent. Why is that? Is it because I’m paying a different rate than Medicare? Are my incentives screwed up? Should I be rethinking how I do pricing and contracting? Or is there some really good reason?’ You can see what is price-sensitive behavior on the part of providers in a way you couldn’t see before. So that’s very valuable, if you’re a private insurer.

“Now suppose you’re a public health researcher. Continue reading

Mass. Medical Society Chief: Medicare ‘Data Dump’ Unfair To Docs

Earlier this month, the federal government released a great torrent of data about Medicare payments to individual doctors — tens of billions of dollars to over 880,000 health providers. Media coverage tended to highlight a small number of doctors who received big shares of the Medicare money, though it also included cautions that there could be good reasons for high payments.

Like many other national and state medical societies, the Massachusetts Medical Society opposed the release of raw data without explanation. Here, Dr. Ronald Dunlap, current president of the MMS, argues that the data may be sowing confusion and doing more harm than good.

By Dr. Ronald Dunlap
Guest contributor

Transparency in health care is a worthy goal, but, like any major undertaking, the success of the effort depends on how it’s done.

When the Centers for Medicare and Medicaid Services released its list of $64 billion in Medicare payments to individual physicians in 2012, it fell short of its goal in helping consumers understand how care is delivered through Medicare.

Dr. Ronald Dunlap, president of the Massachusetts Medical Society. (Courtesy MMS)

Dr. Ronald Dunlap, president of the Massachusetts Medical Society. (Courtesy MMS)

Provided without context and with little explanation, the payment data had the unintended consequences of creating confusion and misperceptions among patients. Here are a few examples why:

• The oncologists receiving some of the highest payments are in private practice, and the data did not note that reimbursements to these physicians include the costs of drugs and treatments as well as payments for physician services. (Oncologists employed by hospitals are not reimbursed for drugs; those are billed to their hospitals.)

• Eye physicians also received high payments, attributable to caring for a growing elderly population with vision impairments like macular degeneration, a condition requiring treatment with expensive drugs.

• In some cases, the number of reported services was misleading, and physicians had no way to review or correct erroneous information. One primary care physician in Michigan was credited with more than $7.5 million in payments. That physician, however, directs a Medicare project that includes 1,600 physicians, who each receive small payments every month. Similarly, a pathologist in New Jersey was listed as receiving $12.6 million, but those payments were spread among nearly 30 doctors.

• The data also omits information about a physician’s patient population, the level of their diseases or conditions, or how long treatments lasted. Nor do the payments reflect the quality of care provided or the demographics of the individual medical practices. A physician with a larger population of patients over 65, for example, will naturally have higher Medicare reimbursements.

Payments to physicians are just one part of health care spending, a complicated and highly variable undertaking that includes a number of variables: the cost of drugs, hospital services, imaging costs, overhead expenses, as well as provider salaries. Also to be figured in: cost controls set by the federal and state governments, added scrutiny by insurers and employers, the creation of new models of care like accountable care organizations, and thousands of billing codes that providers must use to file claims add to the complexity.

Physicians must also account for what is perhaps the biggest variable of all: the patient. Continue reading