April 15th, 2014
Cardiology and the Medicare Data Avalanche
Harlan M. Krumholz, MD, SM
The avalanche of data released by Medicare on Wednesday was followed shortly by an outpouring of news reports. Here’s a review of some of the more significant cardiology-related details that came out in these stories.
Cardiology was the third in a New York Times list of total Medicare payments received by the highest-paid 2% of doctors. This 2% accounted for nearly one-fourth of total Medicare payments. There were 2,176 cardiologists in the top 2% group and they received more than 1.6 billion dollars from Medicare. Ahead of cardiologists at the top of the list were ophthalmologists (2,995 providers who received more than $3.3 billion) and hematologists/oncologists (1,831 providers who received more than $2 billion).
The Washington Post‘s Wonkblog furthered the discussion by asking the top 10 Medicare billers to explain their charges.
What are your thoughts on this recent data? Has there been a discussion between you, your colleagues and/or patients about the information released to the public?
7 Responses to “Cardiology and the Medicare Data Avalanche”
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I believe the electronic data is been used by many for un intended purposes, not in a positive way, and for that reason is not unexpected the result of a new study published online April 14 in JAMA Internal Medicine showing meaningful use (MU) of electronic health records (EHRs) was not correlated with performance on clinical quality measures.
If we continue following this path our profession is going to become the most miserable of all, this point well expressed in the article from The Daily Beast.
http://www.thedailybeast.com/articles/2014/04/14/how-being-a-doctor-became-the-most-miserable-profession.html
The only attribute of this data is transparency of where the largest health insurer in the United States(CMS) distributes its tax derived public monies. Nothing therein denotes value, appropriateness, or quality of services paid. So, what does the public do with this information? Moreover, what does CMS recommend the public do with this information?
Not much new in the annual totals for each specialty. CMS releases that data with the proposed fee schedule each year. Cardiology’s allowed charges peaked in 2007 @ $7.78 billion and has fallen every year since then as fees have been reduced and imaging procedures have moved from offices to hospitals. By contrast Internal Medicine’s and Family Practice’s revenue has grown by nearly a billion each over that time period. Let me know if you want a copy of that spreadsheet.
There is lots of data, but very little information!
I am all for transparency, but ‘unstructured’ and ‘unruly’ data like these can misfire and quickly go rogue.
This data is a misuse of the electronically available information under the guise of transparency. Transparency should include not just raw numbers of the Medicare money collected by individual physicians, but their volume of patient visits and procedures, adjusted for case severity and comorbidities. Additionally, let’s explore transparency of the Part A payments to the hospitals, currently amounting to 26% of the Medicare expenses. It is unclear to me what was the goal of this release, and why it is so specifically focused on physicians before addressing other very powerful and resource intense medical entities.
I think transparency is the first step. I’m sure there are a lot of reporters and researchers parsing through the data carefully as we speak.
In the short term, there will be some negative press, some of which will be unfair. But discussion will also be spurred about how the incentives in our systems are set up. For example, a lot of us are gaining a new understanding for how CMS handles certain biological agent for oncology and opthalmology. In the long term, I think having transparency will help encourage changes in the healthcare system and in individual physician behavior in a direction that promotes better value for the healthcare dollars we spend.
Sometimes the line is blurred between freedom speech and responsible reporting. As a healthcare system and providers we are held to a higher standard. We cannot give an advice under the auspice of freedom of speech without being legally liable, and we cannot publish data or experience without rigorous process of peer review before it is made public. As we are held to that standard, I believe, our payers and potential reporters disseminating the information should be held to the same standard. As our words and advice can potentially harm patients, so will a biased and unsubstantiated opinion swaying the patients to disregard a physician’s advice simply because of their revenues.
I am all for standards in reporting healthcare data by non-physicians as rigorous as that of people practicing in the medical field.