6 Possible Uses of Medicare Doc Pay Info
Written by Editor   
Thursday, April 03, 2014 12:00 AM

The Medicare program will begin releasing to the general public information on what it pays individual doctors as soon as next week, federal health officials said Wednesday.  The data will provide for the first time more specific information on the nearly $77 billion Medicare pays annually to roughly 500,000 physicians and 350,000 other providers in Medicare Part B.

Organized medicine reacted harshly to the news. The data release "will mislead the public into making inappropriate and potentially harmful treatment decisions and will result in unwarranted bias against physicians that can destroy careers," American Medical Association (AMA) President Ardis Dee Hoven, MD, said in a statement.

Jonathan Blum, PhD, principal deputy administrator at the Centers for Medicare and Medicaid Services (CMS), offered a different opinion, saying the information "provides a better picture of how physicians practice in the Medicare program, and the payments they receive."

CMS said earlier this year it would release such information on a "case-by-case" basis starting this spring. But after receiving multiple requests for the information under the federal Freedom of Information Act, the agency decided to release the information broadly on its website, Blum wrote to the American Medical Association.

The data will include which type of the more than 6,000 services and procedures were furnished, certain payment and charge data, and whether care was delivered in a facility or office setting. It will be organized by National Provider Identifier and by Healthcare Common Procedure Coding System codes.  It will not release personally identifiable information about patients or information that represents fewer than 11 beneficiaries.

Here are six ways (good and bad, intended and unintended) the information on what Medicare pays individual doctors might be used.

1. Spotting Fraud, Waste, and Abuse
2. Educating the Public
3. Providing Some Misleading Information
Groups in organized medicine -- including the AMA -- are worried that the information won't be placed in proper context and could damage the reputation of certain doctors.  For example, Medicare pays differently for services in different cities and regions of the country, and many people viewing the information may not be aware of this. Also, the complexity of certain patients and extenuating circumstances may cause some doctors to have much higher charges to Medicare than others.  Some doctors may see a much higher number of Medicare patients, giving them higher number of billings to the program.
"To guarantee that information is accurate, complete, and helpful, the AMA strongly recommends that physicians be permitted to review and correct their information prior to the data release," Hoven said.


4. Making Fodder for Quality Ratings

5. Directing Patients to Low-Cost Providers

One use of such information could be to allow large employers to steer their patients to doctors who have a lower overall rate of spending. This would, in theory, hold down costs for them, Paul Ginsburg, PhD, senior fellow at Mathematica Policy Research, and others have argued.  Other thought leaders in health policy have proposed rewarding Medicare patients with lower cost-sharing for seeking care at more efficient providers.

6. Giving Leverage for Salary and Payment Negotiations

Source:  http://www.medpagetoday.com/PublicHealthPolicy/Medicare/45099