Release of Medicare payment data poses problems, doctors say

Medicare’s payment data dump has sparked backlash from physician advocate groups, including the American Medical Association (AMA) and the American College of Physicians (ACP), who argue that releasing the information without context is misleading.

The Centers for Medicare and Medicaid Services (CMS) published the 2012 Medicare payment information, which totaled $77 billion, for 880,000 physicians and identified physicians by name. But physician groups say that the release, which included more than 2 million lines of data, didn’t include safeguards to help the public or the media interpret the material, Medical Economics reports.

“Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions, and other unintended consequences,” Ardis Dee Hoven, M.D., president of the AMA, said in a written statement.

“Thoughtful observers concluded long ago that payments or costs were not the only metric to evaluate medical care,” Dr. Hoven said. “Quality, value, and outcomes are critical yardsticks for patients. The information released by CMS, will not allow patients or payers to draw meaningful conclusions about the value or quality or care.”

Dermatologists also are expressing concern that patients who review the payment data may not understand the full scope of the type of care being delivered.

“Clearly, patients want to assign blame to those who are paid better by Medicare, but this may be a function of the age of their practice or the concentration of skin cancer treatments in the practice more than avarice by the dermatologist,” says Joel Schlessinger, M.D., who is in private practice in Omaha, Neb. “In the case of one dermatologist I saw who was an outlier in our community, there was both a dermatology practice as well as dermatopathology charges included in the payment numbers.”

Further, the sheer volume of patients seen by dermatologists needs to be considered when reviewing the payment data, he says.

“With numbers up to 4,000 Medicare patients in my community by one dermatologist, this could be interpreted as willingness to see patients who pay 40 to 50 percent of a private pay insurance or milking the system. Clearly, each case is best interpreted separately,” Dr. Schlessinger says.

The AMA outlined nine limitations of the data, which it encouraged media outlets to consider when reporting on the information, including:

1. Errors: Physicians were not given the opportunity to review or correct the information before it was published.

2. Quality: Quality measurements are not included in the data, so the quality of care cannot be evaluated.

3. Number of services: Midlevel providers may bill under the same National Provider Identifier (NPI) number, so it’s not clear who actually performed the services.

4. Charges versus payment: “Medicare and other payers pay fixed prices for services based on fee schedules; therefore the amount paid to physicians is generally far less than what was charged and is not an accurate portrayal of payment,” according to the AMA.

5. Patient population: The data does not include information for private insurance patients and Medicaid patients.

6. Site of service: Where the service was provided may determine the payment amount.

7. Provider comparisons: The specialty descriptions and practice types are not specific, which may make provider comparisons misleading.

8. Missing information: Patient demographics are not included in the data. “To make matters worse, the data includes reimbursements for physician-administered drugs but fails to explain that these payments are compensation for the price of the drugs themselves, many of which are very expensive and are required to treat such serious conditions as cancer and macular degeneration,” according to the AMA statement.

9. Coding and billing changes: Different regions of the country may have different billing rules, and changes should be taken into account.

Shari M. Erickson, vice president of governmental and regulatory affairs for the ACP, echoed those concerns during a presentation at the 2014 ACP Internal Medicine conference in Orlando, Fla.

Ms. Erickson said multiple providers at a group might bill using the same NPI, but within the data it appears that only one physician is providing an impossible number of services.

She also said that the data does not take into account practice overhead costs, the appropriateness of care, or the quality of care. She cautioned that the data would be best used for research purposes to understand variations, rather than for judging individual physicians.

Dr. Schlessinger agrees more clarification is necessary.

“These numbers need a forensic evaluation in order to separate the doctors who are past the point of appropriate billing and those who are lumped with them but serving the Medicare population honestly and efficiently,” he says. “I look forward to having more data points and better methods of parsing the data.”

The AMA says it will continue to work with CMS to develop a process for reporting errors in the Medicare payment data.

Are you concerned with how the Medicare payment data release may impact your practice? Share your thoughts with us at editor@dermatologytimes.com