Doctoring Health Care Reform

Six initial impressions of the Medicare payment disclosure story

What a day it was for medical news. After much legal wrangling, specifically by the Wall Street Journal, the Centers for Medicare and Medicaid Services (CMS) released detailed data on payments to 825,000 US physicians in 2012. It was called a “data dump.”

Wow. Was it ever.

The story was front page news in US newspapers. Social media amplified the conversation. The WSJ featured an interactive tool that allows anyone to look up a doctor, and see exactly what Medicare payments he or she received in 2012.

I don’t like using the modifier “granular” (it sounds so academic) but this is indeed granular data. You can see codes, and numbers of procedures, and dollars, and then compare by specialty and region. You can see a lot.

In the doctor’s lounge today, I showed a number of unbelievers that this was possible. Soon, a small group gathered around a computer. “Hey, look up my numbers.” Once I did, the looks on their faces suggested high levels of neural activity. “How did that guy get such high numbers? What do you mean I only got that little? Oh…look at him up there.”

This, my friends, is a big moment. It’s provocative for many reasons:

1. A very small group of doctors were paid enormous amounts of money. Inequity is a hot topic these days.

2. Certain specialties dominate. This dares us to compare the value of organ systems. Is the heart more important than the eyes or bones? What about my numbers versus my wife’s? Is relieving symptoms of AF that much better for humanity than relieving suffering at end of life? For that matter, what’s the value of responding in the middle of the night? The payments to general surgeons stand out. Geez–those folks look underpaid.

3. The ability to compare payments within regions and specialty tempts us to make judgements about variability in care. Should two doctors in the same region and same specialty vary by that much? Such disparity might suggest someone is not practicing evidence-based medicine.

4. There are strong arguments to be made that some procedures are low in value and high in cost. Value is a thorny topic, but this data forces us to ask hard questions about certain procedures.

5. Is fee-for-service the best system of compensating caregivers? It’s easy to see what pays. It’s surely not talking to patients about eating less, moving more and going to bed on time. Could we do better with incentives?

6. Perhaps the most provocative aspect of this story is whether there will be a collective shunning of context and default to intuitive thinking. Will we take the time to engage our slow-thinking analytical mindset? Will he heed the advice of those who urge us to consider the limits of this data? This NPR post, for instance, outlines the many voices of reason within mainstream media. Don’t rush too judgment is the take home.

Within hours of the breaking story, journalist Jason Millman, from the Washington Post, published responses from many of the top-earning doctors. Yes, there were reasonable explanations for some.

My initial impression of this story is that it is a momentum changer for US health care policy. It’s going to make us look inward, ask hard questions, and engage our thinking neurons.

My brain was buzzing all day. That’s a good thing, right?


6 replies on “Six initial impressions of the Medicare payment disclosure story”

I found it fascinating too, but as a patient, I have doubts about how useful it will be from a patient perspective.

First, the % of medicare payments varies by practice, right? In other words, we looking at some unknown percentage of a particular specialists practice. Seen in this light, the numbers aren’t all that useful.

Second, if you don’t do enough Medicare procedures (10?) in a year to make the list, you’re probably not doing an invasive procedure on me. 10 seems a low annual number, even if medicare is a smaller % of your practice.

Third, and perhaps most importantly, the article about the top 10 [earners, chargers, producers, billers] makes it clear that the data don’t always mean what we think they mean. For example, every procedure done in a clinic with 26 pathologists had 1 guys name on them.

This is always a problem with big data sets. Garbage in–>Garbage out. Having been both on the collection level and the analysis level of a few studies (not medical) – the people on the ground often check the easy or familiar boxes, without the attention to detail that the data collectors would hope.

This fuzziness isn’t often recognized. Remember this when the first analyses come out with accompanying ‘recommendations’.

I believe interactive tools and lists like the one in the WSJ are the beginning of the death march to a single payer system. Over the next few years, you will see a lot more of this stuff. The goal is to make doctors and hospitals look like the bad guys. So instead of correctly blaming Obamacare for the eventual fall of the greatest health care system in the world, we’ll blame doctors and hospitals for taking advantage of the system. Then the government can step in and save us from this corrupt system and give us a single payer system where government can control everything – including what doctors and hospitals can make for anything they treat.

Interactive tools and lists like this also show us just how corrupt of a system we have. And why is that? It’s not doctors and hospitals we should be blaming. It’s government intervention. The more government has gotten involved in the health care over the years, the more corrupt and broken the system has become.

If you want to fix this, government needs to get out of health care. We need to go back to when health care was between the doctor and the patient – period. You pay for your healthcare and you only use insurance for catastrophic events. In short, you to got a free market system in health care. That’s how the system used to work in the early 20th Century. It’s how it works in the auto industry. Hell, even the health care system for pets is free market based and they have better health care than we do.

You get government out of health care and go to a free market system and you’ll see health care costs plummet. Those on Medicare and Medicaid won’t need these programs because the costs of their health care would be so much lower.

The solution is so simple but our politicians would rather control us so facts and common sense be damned. So never mind that government is ruining health care, let’s run stories on how doctors and hospitals are so evil and corrupt. What a bunch of B.S.

Travis Van Slooten

Which greatest health care system in the world is that? We aren’t the greatest in terms of longevity – I don’t consider that a top priority, but most Americans, perhaps especially conservatives, do – nor in terms of infant mortality. We certainly aren’t the greatest in terms of the ability to get treatment for an illness or injury without having our whole family’s finances devastated for years to come. I have friends who live in France and it’s amazing with what insouciance they go to the doctor.

So I assume if you’re ever diagnosed with cancer or some other catastrophic disease you’ll be heading to France or some other European country to get treated? Of course not. America is where everyone turns to when they want top-notch medical care. The best medical advances…the best doctors…the safest procedures…are in the U.S.

And what’s truly astounding is that we’ve accomplished this DESPITE government constantly getting in the way. Imagine what our healthcare system would look like if it was truly free from government bureaucracy?


P.S. The argument that people live longer in other countries so therefore they have better health care is a crock. They live longer because they live healthier lifestyles (i.e. they eat better). It has NOTHING to do with the healthcare they receive. Again I ask you, when sh*t hits the fan, where do you want to be treated?

Travis – “USA, USA!” is not a statistical argument. Yes, America has many fine doctors and hospitals. So do quite a few other countries. Americans are not inherently more intelligent than other human beings and they are not the only people to possess “modern” technology – in fact, some treatments now used in Europe and Asia are not available here. I personally, since I have moderately high-deductible health insurance and only modest savings, would find it economically easiest to obtain expensive treatment here, and certainly it would be easier on my family. But there are Americans who do go abroad for surgery because they are paying out of pocket and it costs them 10% of what they would pay here.

Most medical care is not for “TSHTF!!!!” situations. It’s for the cases of flu, the Type 2 diabetes, the sprained ankles, and any modern healthcare system can handle these things, often better than ours and with less cost in money and side effects. But when whatever-it-is finally hits the fan for me, I’d prefer to wrap up my affairs and die fast enough that my husband isn’t left destitute and devastated by having had to watch me slowly turn to mush. And without ironclad paperwork, in the U.S.A. your chances of dying hooked up to a bunch of machines whether you like it or not are enormously higher than they are in most secular nations.

Short opinion: i think doctors and teachers should be paid very good because the first ones save lives everyday and the last ones are teaching how to save lives.
Best regards

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