Massachusetts’ Medicare Millionaires
Friday, April 11, 2014
Nationwide, $64 billion was issued in individual reimbursements, a third going to less than 3 percent of doctors, with nearly 4,000 physicians billing at rates of $1 million or more annually. In Massachusetts, the top 30 doctors on the list divvied up more than $45 million in payments.
See Highest Medicare Reimbursed Docs in MA BELOW
“Data transparency is a key aspect of transformation of the health care delivery system,” CMS Administrator Marilyn Tavenner said in a news release. “While there’s more work ahead, this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program.”
While some advocates are lauding the data release, others, including the American Medical Association, are questioning the purpose.
"We believe that the broad data dump today by CMS has significant short-comings regarding the accuracy and value of the medical services rendered by physicians. Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences," said Ardis Dee Hoven, MD, President of the AMA.
Hoven continued, "Thoughtful observers concluded long ago that payments or costs were not the only metric to evaluate medical care. 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 of care."
Support for Transparency
"The data release marks a very important first step, because Medicare is the nation’s largest health care program that serves our oldest citizens, and those most likely to face health care issues. Until now, many insurance companies, health systems and communities have worked with similar information, when they could get it, on under-65 patients. You can look at our recently announced DOCTOR Project as an example of what can be done with this kind of information," said Weiss.
Weiss continued,"This really turbocharges giving people the information they need to make health care decisions. When Medicare released hospital pricing data last year, it was downloaded over 300,000 times in its initial release. While more needs to be done to drive home the importance of this issue with consumers, more information is helpful. I compare it to the difference between a restaurant with one Yelp review and one that has 500.
Still, Weiss thought there was opportunity to bolster the effort.
"More needs to be done to get to further transparency. Many contracts between health insurers and providers contain “gag clauses” that bar both parties from disclosing claims data or prices paid for care. California has outlawed such clauses in health plan contracts," said Wiess. "What’s more, a total of 16 states have set up mandatory or voluntary all-payer claims data bases (APCDs) to pool statewide data on diagnoses, procedures, care locations, and provider payments. More states could also follow the lead of Maine Quality Counts, which has aggregated health plan data for purchasers, consumers and providers to promote transparency on quality and cost.
"While we agree that more transparency in health care is a good thing, and that the prevention and discovery of fraud and abuse is also important, the Massachusetts Medical Society shares the American Medical Association’s concerns about what people need to consider when evaluating physician information," said Dunlap. "The AMA has outlined the following concerns about the release of the CMS payment data:
1. The data could contain errors. Physicians don’t have a way to review or correct the information reported.
2. Care quality can’t be assessed from the information reported. The data focuses solely on payment and utilization of services and doesn’t include explicit information about the quality of care provided.
3. The reported number of services could be misleading. For instance, residents and other health care professionals under a physician’s supervision can file claims under his or her National Provider Identifier, and the data may not properly detail who performed the services.
4. Billed charges and payments aren’t the same. CMS will report both the physician’s billed charge and the actual amount paid, which is set by the Medicare Physician Fee Schedule. Payments generally are much less than the billed amount.
5. The data doesn’t represent the physician’s patient population. The data won’t include services related to non-Medicare patients or account for the complexities of the physician’s patient population; it is not risk-adjusted.
6. Payment amounts vary based on where the service was provided. Medicare pays physicians less for services provided in a hospital outpatient department than for services provided in the physician’s office to reflect a difference in the practice costs. But Medicare makes another payment to the facility to cover its practice costs when services are provided in the outpatient department. That means that in reality, the total costs to Medicare and the patient may be higher when a service is provided in a facility setting.
7. The data doesn’t enable clear comparisons of physicians. Specialty descriptions and practice types aren’t very specific, so physicians who appear to have the same specialty could serve very different types of patients and provide a dissimilar mix of services, making some subspecialists appear to be “outliers.”
8. Important information is missing. The data does not account for patient mix, patient demographics, or drug and supply costs."
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