Monday, February 02, 2015
The U.S. government will begin releasing Medicare physician-payment records every year, cementing public access to how tens of billions of dollars are spent annually on everything from office visits to radiation therapy.
Last April, a year’s worth of the data was released for the first time in more than three decades after Wall Street Journal parent Dow Jones & Co. challenged a 1979 injunction that prohibited Medicare from disclosing its payments to doctors. It was unclear at the time if any more records would be released.
The data provided the first comprehensive look at a central part of the taxpayer-funded program for the elderly and disabled. It detailed payments to 880,000 individuals and organizations totaling more than $77 billion from the Medicare program in 2012, covering more than 5,000 different procedures.
The records had been kept secret through legal efforts by the American Medical Association, which argued a doctor’s right to privacy outweighed the public’s interest in how tax dollars were spent. A federal judge in March 2013 vacated the 1979 injunction.
A spokeswoman for the Centers for Medicare and Medicaid Services, the agency that runs Medicare, said the government had decided “to update the data annually” despite the concerns of doctors’ groups. The agency didn’t say when it expected to release the next batch of records.
The AMA, the main physicians’ group in the U.S., has urged the Department of Health and Human Services not to release any more payment information before making improvements to the data set. The group said information published last spring, which covered payments in 2012, had inaccuracies and exposed its members to “sensationalist” news coverage.
The data released in April included most payments to doctors, laboratories, ambulance companies and other medical providers under Medicare Part B, which makes up about one-seventh of the program’s nearly $600 billion in annual expenditures.
Over the past year, the Journal has published a series of front-page articles illustrating how the Medicare data can spotlight potential fraud, waste and abuse.
A Journal article in June, for example, looked at physicians with high billing levels—including a urologist who collected nearly $1 million for a rarely used bladder procedure. The urologist said he acted in his patients’ best interest.
The article moved Dr. John Libertino, chairman of the Institute of Urology and CEO Emeritus of the Lahey Clinic, and a colleague to alert the American Board of Urology to conspicuous billing outliers in their specialty.
The board agreed to a review, Dr. Libertino said, and indicated it would take action against some doctors. Dr. Gerald H. Jordan, executive secretary of the board, said any investigations or decisions were confidential.
“The majority of physicians—I would say 90% or 95%—are good people and don’t take advantage of the public trust,” Dr. Libertino said. “But I do think there are some people who need to be weeded out.”
Investigators, consumer information companies, health care providers, as well as other media outlets, also used the data.
At BetterDoctor.com, Ari Tulla, chief executive and co-founder of the San Francisco, Calif., company, incorporated the information into a searchable national database that already includes a range of data sources, from peer reviews and consumer feedback to academic history and hospital quality.
“Think about a hotel rating: You know they have a pool, you can read the feedback,” he said. Medicare data, he added, is the hotel-guide equivalent of seeing “the cleaning report from the manager.”
The AMA said last year in a letter to Medicare that any new data should offer more context for the services doctors performed. For instance, total payments might appear high for some providers if they reflect several people from one office billing under a single provider number.
The AMA also said the data didn’t always represent what the doctors actually earned in income under the federal program. For example, some of the biggest earners in the 2012 Medicare data were ophthalmologists. But their reimbursement numbers can be misleading: Sometimes they include the costs of such expensive eye drugs as Lucentis, used for macular degeneration, which doesn’t necessarily make much money for the doctor.
The government declined to say whether it planned to alter or expand the next trove of data. The 2012 data contained no information about patients, for instance, precluding analyses about quality of care or patient outcomes.
In an editorial in the New England Journal of Medicine last May, government officials said the first batch of data had been downloaded or accessed more than 300,000 times online in the weeks after its release.
“The cost of health care is soaring and we really need to get a handle on where the money is going,” said William B. Jordan, president-elect of the National Physicians Alliance, a nonprofit organization. “I don’t think you can do that without transparency.”
Dr. Jordan, who practices family medicine at a community health center in the Bronx, N.Y., said he used the 2012 data when a cardiac surgeon treating a family member recommended a procedure that the relative had already had once before.
After seeing the surgeon’s Medicare reimbursements were in line with peers, Dr. Jordan said, “It made me feel like he probably didn’t have an ulterior motive for recommending the procedure.”
Gail Wilensky who headed Medicare from 1990 to 1992, said the next installment of data could deepen perspective on health-care patterns and Medicare spending.
“As imperfect as the data may be,” she said, “its continued release makes it in the physicians’ interest to make it better—more useful and accurate—instead of just fighting its release.”
http://www.wsj.com/
