It’s open season on doctors in the national media sport of doctor bashing. Doctors have been blasted by innuendo by media of all stripes in a hail of articles trumpeting the release of Medicare payment specifics about how much Medicare paid to each of over 800,000 Medicare providers.
This release of Medicare payment specifics has been the Holy Grail of media doctor bashers. But even though they have reached the Promised Land, so to speak, the question remains whether the data dump serves the media’s purpose in discrediting fee-for-service payments and drive hapless medical consumers – formerly known as patients – into the Holy Grail, Part II – capitated and bundled payments at the hands of managed care arrangements.
I first wrote about the media’s attempts to tar doctors with charges of massive “fraud, waste, and abuse” way back in 1996 in an article for Forbes MediaCritic. In that article I traced the oft-quoted figure of 10% of all medical care being due to “fraud” and “abuse” to a flawed consumer survey by Aetna. And I reviewed how, in 1992, the Cox Newspaper Group had published a list of “million-dollar doctors” in six states based on some data on Medicare payments they were able to cobble together.
For that article, I interviewed Bruce Vladeck, the then Administrator of the entity that ran Medicare, the Health Care Financing Administration (HCFA). (It’s now called CMS.)
Mr. Vladeck was not bashful in stating that measuring (and publishing) how much Medicare pays individual doctors was not a particularly useful way to detect fraud. He said, “There are an awful lot of ways of cutting the data to try to identify physicians or other providers whose claims need to be investigated. Cutting it by gross billings is not a particularly effective way of doing it.”
But that never stopped the national media.
I haven’t read all the articles on this topic linked on my daily American Health Lawyers Association newsfeed. But I did read the April 9, 2014 USA TODAY article while traveling. Charitably speaking, it’s a joke. No, more correctly, very bad journalism.
On page 1A (April 9, 2014), the headline screamed: “Doctors’ Medicare pay revealed. Data show 7 received more than $10 million.” The two reporters, Meghan Hoyer and Kelly Kennedy, state, “Releasing the data could help consumers understand health costs, help providers deliver better care and enable journalists and advocacy groups to sniff out fraud, experts say.”
But the reporters don’t tell us say who those experts are on Page 1A. But does it really matter? Does anyone think these two reporters are going to report how these data will help consumers understand health costs and “sniff out fraud?”
If sophisticated fraud detection units of Medicare, Medicare payment contractors, Medicaid, and private insurance carriers can’t make a case for fraud now, just how are journalists and consumers going to figure out fraudulent claims? How many consumers can unleash FBI agents to raid a doctor’s office? How many journalists can get access to medical records to see if a medical test was necessary?
On page 4A of yesterday’s USA TODAY, the two reporters then go on to report in an article, “Looking under hood of Medicare,” that “… this could be a tool for outsiders to look for trends that computers miss.” Lots of luck with that one.
I can just see some seniors in rural Iowa having breakfast meetings at the only café in town (You know, the one the presidential hopefuls will be appearing at soon to bash doctors.) to go over their suspicions about which of their doctors is doing unnecessary tests that Medicare computers haven’t been able to detect. While they’re at it, they can compare notes as to which doctors are still taking Medicare patients. They may have seen that one of the top billing doctors fingered by the data and by the media hounds runs the laboratories at the Mayo Clinic in Rochester, MN, and Medicare attributed millions in payments to this one doctor when in fact the monies went for “tens of thousands of analyses” at the Mayo Clinic — many of which are for Iowans who regularly go there for medical care. But, I digress.
Here’s a part of the article that I can’t understand. Maybe you understand it:
“Still he (an attorney) said the data could show which types of providers are overvalued, and which are undervalued. The data include repayment rates for various specialties, which can vary widely based on how much “work” is included: if it’s a surgery, are there technicians involved? Does a specialist do more “work” than a nurse practitioner? Does a speech pathologist require the same technology as a radiologist? Does a physician assistant require the same training as a cardiologist? HUH????
Let me try to answer the incoherent questions posed for the two intrepid reporters:
Yes, technicians are usually required for surgery in a hospital or surgery center. And nurses are involved, too.
It depends on what the specialist and the nurse practitioner are trying to do. Did you have something in mind?
Maybe: Are you talking about a speech pathologist doing a barium swallow to evaluate reflux and aspiration vs. a radiologist?
I hope not. A physician assistant might require the same training as a cardiologist for doing an EKG. But for putting in a cardiac stent, probably not.
Then, there are quotes from Deborah Ness, the president of the National Partnership for Women and Families, an organization with a track record of doing good work to secure equal pay for women and reproductive rights, and even attempts to see that women had access to appropriate specialty care in managed care arrangements.
But when it comes to using Medicare pay data, USA TODAY reported Ms. Ness opined, “Even though the data do not include outcomes, Ness said, experts could see whether unnecessary care added to costs while necessary care was overlooked.”
Memo to Ms. Ness and the two reporters: The release of Medicare pay data will furthermore undermine public confidence in doctors and in the fee-for-service payment method. That will drive most consumers into managed care arrangements where there is virtually no transparency. If you think it’s hard now to figure what part of care is over care vs. what care has been skipped ( under care), just try to figure over care vs. under care out when Medicare pays hospitals and HMOs lump sum payments as in capitation and bundled payment arrangements. You won’t be able to tell which corners were cut and who died sooner than necessary. Throw in some tort reform to keep attorneys from using subpoena powers and courts to try to get at under care, and you will have an HMO executive’s dream outcome.
Ms. Ness only has to look at her board of directors, with executives from the UnitedHealth Group, CVS Caremark, and several law firms that represent large health care entities to see how her support of the Medicare data release serves the political and financial interests of her board, rather than the interests of women trying to get access to doctors they can trust.
Don’t get me wrong: I am all for transparency in both process and outcomes. But big data doesn’t lead to understanding the complexities of what consumer advocates want access to: lower costs and figuring out which doctors and hospitals give high value care. That will require the much more difficult process of measuring and reporting outcomes of care. Gross charges and payments received only muddy the waters and distract us all from measuring real patient outcomes in a clinically meaningful way.
In my next blog, I’ll review more articles on this subject.