Public discourse on payments

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 - CandaceStuart
Candace Stuart, Editor

The Centers for Medicare & Medicaid Services (CMS) released data this week on approximately 880,000 physicians who received Medicare payments in 2012. The information is both revealing and misleading.

Opponents to the public airing of payments to physicians warned that it would be confusing to the public, who wouldn’t understand the complexities of the reimbursement system or of medical care. The thought was that patients and others using the database would assume the lump-sum amount listed with a specific physician was money personally pocketed.

This is not necessarily the case, as has been illuminated in a variety of reports. Overhead costs eat up some reimbursement—sometimes much of the payment. Some cases use a physician’s National Provider Identifier that is the funnel for payment in programs that involve many healthcare professionals. Some cases are complex and time consuming.

The federal government has been flagging outliers who receive Medicare payments in great excess of the average payment. The more than $18 million that was paid to a cardiologist in Florida was among the very top payouts in 2012. According to the New York Times, the cardiologist and his facility already have been under “prepayment review,” a process that examines Medicare billing before authorization. It is unclear when that was enforced.

It is possible the $18 million, or any of the payments listed in the database, are erroneous. Physicians have not had the chance to review the data for accuracy. It is also possible the $18 million was appropriately billed and conformed to federal requirements.

The U.S. Department of Health and Human Services claims making information about Medicare charges and fees will inform the public and help in decision making. Will it make beneficiaries pause before undergoing an expensive procedures? I suspect only if they incur high out-of-pocket expenses and not if the overall costs are high.

What this may prompt—and may be one intent in unveiling this data—are discussions not by beneficiaries but by taxpayers about the value of some medical procedures. Physicians want to provide the best care they can to their patients, but given limited resources, some options have to fall outside reimbursement.  

Cardiologists should have a say in this discussion, either directly or through physician advocates. Read more here about what advocates do, why and how.

Candace Stuart

Cardiovascular Business, editor

cstuart@cardiovascularbusiness.com