Medicare Payment Data Lacks Context, Portrays Physicians Poorly

On April 9, the Obama administration released data on CMS.gov detailing the dollar amount of Medicare payments to individual physicians.

The massive data dump is part of a move designed to open the books on healthcare financing.

The story was quickly picked up by newspapers across the country. 

A Dallas Morning News headline screamed, “340 Texas doctors among Medicare's millionaires,” and the LA Times reported: “Medicare pay data shock and anger many doctors listed as high earners.”  The New York Times went further, creating a searchable form, under the headline, “How Much Your Doctor Received From Medicare.”

The shock waves, which are just now being felt, will likely have long-term implications in the debate on healthcare financing. This is exactly what the Obama administration intended.

Unfortunately for many doctors, the data without context is misleading, and it may cause many patients, and the public, to view you in a different light.

The conservative group, the Association of American Physicians and Surgeons (AAPS), goes even further in a released statement. “Medicare’s release of data on physician payments serves no purpose except to further the federal government’s war on doctors. Doctors are the scapegoats for the program’s bankruptcy. Most of the high payments are for very expensive drugs for macular degeneration or cancer chemotherapy. Doctors’ earnings are a very small fraction of the amount."

The experience of Newport Beach oncologist Minh Nguyen would seem to bear out the AAPS’ assessment. Nguyen woke up Wednesday with the distinction as the highest paid doctor in California, according to a story in the LA Times. Federal data show he got paid $11.3 million for treating Medicare patients in 2012. 

Nguyen told the LA Times that the data lacks context. He explained that five doctors bill under his name, and much of the payment he received covered expensive chemotherapy drugs for which there is a tightly controlled markup.

"Without an explanation, it looks like doctors are making a gazillion dollars," Nguyen said. "Holy smoke, if I made $11 million I would have a private jet. It's ridiculous the government can release these numbers and make me look like a bad guy. I make a good living, but I'm not making seven figures."

In addition to lacking context, part of the problem with the "data dump" may be that doctors shouldn’t be billing under each other’s NPI numbers.

According to the LA Times, Medicare officials criticized the practice of multiple medical providers billing under one person's national provider identifier. Still, they didn't say it was forbidden.

The AAPS criticizes both the purpose and the effect of the data dump. “Asking the public to help ferret out fraud is a sign of the incompetence of the program, which pays out millions to fraudulent operations that are not providing any real services to patients while it buries honest doctors in compliance paperwork." 

In my way of thinking, the government knows exactly what it is doing in releasing the data.  The data dump, which casts doctors in the role of “Daddy" Warbucks, comes just 10 days after the public enrollment period expired for obtaining a policy under the Affordable Care Act. Thus, while many Americans are thinking about paying for the cost of their new coverage, or the penalty they will pay at tax time, the administration releases a report tending to show doctors are living large on government paychecks.

It is a Sustainable Growth Rate public relations coup. Each year, CMS sends its report to the Medicare Payment Advisory Commission, which advises the U.S. Congress on the previous year's total expenditures and the target expenditures. If CMS, which released the data, can make it appear that doctors are getting rich from Medicare payments, even if the data is misleading, then it is easier to cut payments to physicians in the future. 

Have you looked up your payment data? Do you feel that it fairly reflects what you earned? Share your thoughts in the comments section below.