The big headline on Wednesday was the Centers for Medicare and Medicaid Services’ (CMS) identification of 2012 physician payments. Included in the data is the providers’ names, addresses, specialties, billing rates, the amount paid by Medicare, number of Medicare beneficiaries and number of services provided for every Medicare provider. Note that only procedures performed on more than 10 patients were included and data on durable medical equipment (think canes and walkers) was not included. USA Today published a nice interactive map of payments by state here.
This is a good thing and a bad thing.
Why is it a good thing?
- It promotes pricing transparency, although anyone can go to the Medicare Physician Fee Schedule lookup site and find out what a physician gets paid for services. For that matter, Medicare patients get individual statements showing what their physicians are paid, as well as quarterly statements showing all Medicare payments on their behalf for the past three months. So what Medicare pays has been available to the public for a long time, although not cumulatively.
- Might the publication of data bring to light the fraudulent providers? it’s certainly possible. But shouldn’t Medicare have already found the physicians whose billings seems out of proportion to the average physician of that specialty?
Why is it a bad thing?
- Sensationalism: As with all things healthcare these days, it makes for sensational headlines. CNNMoney says “Doctors make Millions Off of Medicare.” What does that smack of, if not that all physicians are getting rich off the taxpayer dollar? CNN states “…nearly 4,000 are Medicare millionaires.” If Medicare is the motherload, why are physicians closing their doors to Medicare patients, or limiting their panels? Why don’t all doctors see ONLY Medicare patients, if it is such a sweet ride?
- They make how much? Medicare payments to physicians do not equate with physician’s take home pay. Revenue is used to pay for staff, medical equipment, technology, rent, utilities, and drugs, to name a few. Expenses in medical practices take between 50 and 75 cents of every dollar that a practice receives.
- Who really got paid? Payments are categorized by National Provider Identifier or NPI, and it is often the case that clinicians working for or under the physician (for instance Nurse Practitioners or Physician Assistants) bill and are paid under the physician’s NPI.
- Drugs tip the scale: Some of the most costly Medicare payments are for drugs, so while it may seem that the physician is receiving a hefty payment for administering a drug (during chemotherapy, for instance), the majority of that payment is to reimburse the practice for the drug, as Medicare only allows physicians to charge 6% above the average wholesale price, which has to cover the practice’s expense for ordering, receiving, storage, mixing, payment, documentation, and disposal.
- Clean data? Physicians were not given an opportunity to review the data before it was released and bring any errors to the attention of CMS.
- Only part of the overall picture: The data only covers original Medicare services, not those provided to Medicare Advantage (replacement) plans or to Medicaid, nor does it report on any commercial payers or self-pay patients.
- Meaningful data? There is nothing to qualify the acuity of the patients, the age of the patients, or the quality of the care. When proponents state that consumers can use this data to make better care choices, I have no idea what they’re talking about.
Although my list of “bads” is longer than my list of “goods”, I ultimately believe the release of this data is a good thing because it draws back the veil of secrecy.
What do you think – is the publication of Medicare data a good thing or a bad thing?