Why Healthcare Providers Are Concerned About The CMS Data Dump

In two editorials published in the Annals of Internal Medicine, Gail Wilensky, PhD, a former administrator for the Health Care Financing Administration; along with Eric M. Horowitz, MD, and David S, Weinberg, MD, MSc, both of Fox Chase Cancer Center, shared their concerns about the release of physician payment data by CMS.

All three of the authors cautioned against evaluating the data without context because a monetary figure does not provide any context about the types of services performed, the number of clinicians billing to one practice, or the types of services being rendered.

“The purported purpose of the data is two-fold: To help detect and ferret out fraud and abuse, and to help consumers or patients make more informed choices about which physicians they should choose,” Wilensky wrote.

She added that being a high biller is “not necessarily a sign of fraud or abuse” because of the size of a practice or the type of illnesses being treated. Patients might be able to use the data to better understand which physicians perform higher volumes of certain kinds of treatments, but the data could also be “misleading” without context, she said.

Horowitz and Weinberg also wrote that the data lack context, and the use of an “interactive tool” to view their own data and that of colleagues left them “confused and concerned.”

The two physicians wrote, “Wide variations invite thoughtful discussion of how best to allocate finite resources. The amount of money in question and the potential for misuse demands it. However, comparing the annual Medicare payments to a physician or medical specialty without deeper consideration of the data represents misuse as well.”

The two Fox Chase authors also wrote that the interactive tool “reduces 10 million lines of data on 880,000 physicians performing more than 6,000 Medicare-covered services to one annual payment per physician,” and added that the amount of administrative and other overhead costs vary greatly by practice. “Still, we can only guess at the explanations for the variability of these data. Our colleagues in health care finance had differing explanations. If persons involved in the daily practice and economics of medicine cannot decipher these figures, where does that leave patients?”

Geographic variation was noted by the two authors, but the type of care may be more influential to cost, particularly in treating cancer, so caution should be used in reviewing the numbers. “Used carelessly, [the data] may provide great headlines, gossip and controversy but will offer little insight, thereby hindering — instead of promoting — efforts to improve health care value.”

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