The architects of the release of physician-specific Medicare payments and the president of the American College of Cardiology (ACC) agree on at least one point: Making the healthcare system’s costs more transparent is a good thing. But they part ways on the quality and usefulness of the data made public in April in two perspectives published online May 28 in the New England Journal of Medicine.
“It is one small step toward transparency with respect to cost,” Patrick T. O’Gara, MD, of Brigham and Women’s Hospital in Boston, told Cardiovascular Business.
O’Gara, who presides as president of the ACC, reiterated in the perspective many of the points raised by medical societies before and after release of the data. Those included the lack of any risk adjustment; no acknowledgment of the complexity of the care of patients; no measure of the quality of care; no opportunity for physicians to review the data for accuracy before its release; and no explanation that costs linked to a National Provider Identifier numbers may reflect multiple users and overhead.
“It would be erroneous to assume that comparing one person against the other is really comparing apples to apples,” O’Gara said. “It is much more complicated than the average patient may understand or want to understand.”
Niall Brennan, MPP; Patrick H. Conway, MD; and Marilyn Tavenner, RN, MHA, all of the Centers for Medicare and Medicaid Services, provided a perspective in defense of the release of what they described as “raw” data. “All these points have some merit, but we concluded that these issues did not outweigh the overall benefit of releasing the data,” they wrote. “In particular, we view this data release as an important first step in building greater understanding, on the part of a diverse community of policymakers, data entrepreneurs, and consumers, about the way in which Medicare pays physicians and other providers.”
They expressed confidence in the accuracy of the data and suggested that physicians who think their reimbursement and other data are wrong may be victims of foul play and should follow procedures for reporting suspected fraud.
Many physicians probably looked their data up when it was made public, but it would have been impractical for many of them to try to verify submissions from 2012, O’Gara noted. For academic physicians like him, whose residents and fellows may submit claims under their supervisor’s number, it would be an especially time-consuming task. “It would take me a week,” he estimated.
In his perspective, O’Gara held out hope that if limitations such as risk adjustment and accuracy are addressed then the data might be linked to other resources that could provide insights on quality and outcomes. He also saw opportunity for engaging patients in the discussion of cost.
“I am sure there will be iterations of people trying to do reasonable research off the data release,” he said.
He added that there has been more of a wait-and-see reaction than a rallying cry from the ACC membership about the data release. “There is a hope that this is just a first step and refinements will be made over time so it could be useful. The ACC embraces the idea that there should be cost transparency but if we had to choose, we wouldn’t have dealt the cards in this particular order.”