Why physicians are concerned about public access to Medicare payment data

In a move to increase transparency and accountability, the Centers for Medicare and Medicaid Services (CMS) recently released data on Medicare payments made to physicians. Previously confidential, this information is now available to the public.

The raw financial data files, available in Excel and tab delimited formats, encompass more than 880,000 healthcare providers and approximately $77 billion in Medicare payments received for the Part B fee-for-service program in 2012.

While this information can help patients in the process of selecting a physician — and may also support those who believe healthcare needs to move away from a fee-for-service model — many have concerns about the data’s limitations and lack of context.

The CMS website explicitly notes several limitations. Specifically, the information shows only Medicare Part B fee-for-service payments, so it’s not representative of a physician’s practice as a whole. Also, factors such as quality of care, severity of disease, and the varying needs of different patient populations are not reflected.

Due to the lack of context surrounding this data, the American Academy of Family Physicians (AAFP) published an analysis in the form of a four-page PDF. The resource outlines a number of limitations:

  • No explanation of the costs incurred, meaning the payment information does not accurately represent physician compensation
  • No measurement of the quality of care
  • Doesn’t clearly show the services performed or who performed them (healthcare professionals working under a physician’s supervision can file claims under that physician’s identification number)
  • Represents a limited portion of each practice’s patient population
  • Doesn’t identify the locations where services were provided, which can impact the total Medicare payment
  • Indicates physicians’ specialties but does not account for differences in patient and practice types
  • May be affected by changes in Medicare’s coding and billing rules
  • No formal process established for physician review and appeal in the case of errors

The AAFP also voiced concerns about how the data may be used against physicians. For example, insurers could use the information to require additional prior authorizations. Hospitals and insurers may compare physicians’ charges and drop those considered to be “high cost.” Patients, the media, and others may interpret the payment figures out of context, furthering the perception that doctors are overpaid.

In light of these limitations, what can you do to make sure your patients use the data wisely?

Whether you appreciate the effort to provide transparency, have concerns about how the data will be interpreted, or see both the pros and cons of publicly releasing the information, it’s important to point out that the data has limitations and lacks full context. Patients who take a look at the data may not keep these limitations in mind. And in that case, they may not consider the fact that the numbers don’t reflect quality of care and that they don’t show a complete picture of an individual practice.

If you think your patients will have questions about Medicare payment information, take some time to put together a few talking points. Being informed and prepared will allow you to provide a clear explanation and have an open discussion.

 

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