Release of Medicare Payments Sure to Cause Confusion

The release by the Centers for Medicare and Medicaid Services of payment information for doctors and healthcare providers is sure to cause concern among patients and garner the attention of regulators, auditors, insurers and government enforcement agencies. The release of the data, as a result of a court decision, has opened the window into the payments made to all providers who received Part B payments. The release is making headline news because of isolated cases of high payment rates. For example, one ophthalmologist reportedly was paid $21 million alone in 2012.

What is not being highlighted is that the overwhelming majority of the payments made to doctors were on average only $57 per visit. Nor is the focus on the continued decline in payments from both government programs and insurance programs or the impact of sequestration on providers. Providers are under siege from all sides. There is increased regulation. And then there is the onslaught of auditors fueled by the desire to apprehend a small minority of corrupt providers (who rightfully need to be stopped) has placed a tremendous burden on many practices. The audit system now in place is expensive and time consuming. The primary benefit is to the private auditing firms that make millions of dollars, while the patients suffer as the doctors and their staffs are overwhelmed by the demands placed upon them.

But what will this new data show us? As with any data, it’s only as good as the analysis. Knowing that a certain procedure was paid out at over $1,000 is not helpful if you don’t know that it includes the costs of an expensive drug. Nor is it particularly informative to know that a certain oncologist has a tendency to prescribe an expensive scan, if you don’t know that she is a leader in a very specific field with a high success rate.

What we can expect is that regulators and public and private auditors will be pouring over this data. The window has been opened on the medical and financial records of individual patients and doctors. While, some good will come of this, is there any reason that such results could not have been reached without further intrusion. This information has always been available to CMS. By putting it out in the open, more privacy is lost and undoubtedly false claims are going to be made against the providers. Providers will need to respond promptly and fully to these claims in order to avoid the onerous penalties associated with audits. Unfortunately, taking away more of the doctors’ time from patients. There is much to be said for full disclosure, but it comes at a price.