CMS Releases Doc-Specific Pay Data
The Centers for Medicare & Medicaid Services released a vast – and at times incomplete – database of provider-specific payment data Wednesday after years of often acrimonious debate about whether such numbers should be made available to the public.
The agency said it decided to release the data, which covers fiscal 2012, after weighing the privacy rights of the providers against that of the public having more transparency in financial vagaries of healthcare delivery, where the cost and pricing of care can vary widely depending on provider and geographical area.
“We believe the public has the right to know this information,” said CMS Principal Deputy Administrator Jonathan Blum at a news conference on Wednesday. Blum added that the fact the Medicare program was funded by taxpayer dollars was among the factors in making the data available.
Although Blum also asked the general public to comb the data in assisting the agency in cracking down on potential Medicare fraud, both he and other CMS officials took pains to note that high rates of billing by individual physicians was not necessarily an indication of wrongdoing.
CMS had released hospital-specific billing data last year, and Blum noted that it woud be updated again by late spring to make matching material from both databases simpler.
The Obama administration had suggested in recent weeks that it would release the physician-specific information after lawyers for the Wall Street Journal were able to get a decades-old injunction against publishing physician-specific Medicare billing data lifted in federal court in 2013.
The newspaper reported in 2010 that a small Kentucky hospital was one of the largest billers of Medicare for spinal fusion surgeries in the nation, and that several surgeons there may have engaged in an outsized number of the procedures in order to receive royalties on screws they had patented for the procedures. However, because of a federal injunction the American Medical Association obtained in 1979, the Journal was unable to disclose the names of the doctors.
According to the data CMS released on Wednesday, about 1%of the physicians participating in Medicare reap about 14% of payments. Many are oncologists and ophthalmologists. CMS officials noted that the pricey drugs connected to the treatment of cancer and eye patients contributed to their steep charges and payments.
Although the CMS's decision could be a game-changer in terms of healthcare price transparency in the coming years, its process for releasing the data was far more friendly to news and other organizations with the finances and capabilities to set up databases to accommodate them than the average consumer.
The master file released by CMS was nearly 2 gigabytes in size, contained more than 9 million records, and could not be imported into widely available consumer programs such as Microsoft Excel. Instead, the numbers in that file could only be crunched and refined by organizations with relatively sophisticated IT systems.
CMS did break data into separate Excel-compatible spreadsheets. However, each had about 75,000 entries apiece, making opening and deciphering the files in a relatively swift manner by any device other than a top-notch computer challenging. The files also remained too large to import into popular cloud-based applications such as Google Drive.
Although the master database contained physician payments based on specific procedures and the number of times it was performed, a file that contained Medicare charges in the aggregate appeared incomplete, based on a review by Payers & Providers and a comparison to reports by other news organizations.
For California, CMS released aggregated payment data on more than 5,300 providers who billed the Medicare program $1.8 billion in 2012. But several large billers were missing from the database, mostly notably Newport Beach oncologist Minh Nguyen, M.D., who was said to have received Medicare payments ranging anywhere from $9 million to nearly $12 million, depending on the news organization doing the reporting.
Instead, David R. Minor, M.D., a prominent San Francisco oncologist, was listed as being the largest individual recipient of Medicare payments in California, charging the program nearly $9 million and receiving $3.53 million. The names of the physicians who practice with Minor in the San Francisco Oncology Associates medical group were also absent from the database, suggesting he may have received payments on their behalf as well. The administrator of San Francisco Oncology Associates said on Wednesday that Minor was not yet prepared to comment.
Another absence from the aggregate list was even more glaring: Salomon E. Melgen, M.D., a Palm Beach, Fla. ophthalmologist who received $20.8 million in Medicare payments for treating just over 900 patients in 2012. Melgen, whose offices were raided twice last year by the Federal Bureau of Investigation last year and had been ordered to repay Medicare $9 million, was listed as the program's most highly-compensated individual physician. Melgen’s name was also absent from the 12 separate databases that were broken down into alphabeticized sections.
The second and third-highest individual billers in California on the aggregate list were Sachin Kamath, M.D., a radiation oncologist in the Northern California city of Pleasant Hill; and W. James Gealy, Jr., an ophthalmologist who practices in the Central Coast town of Templeton. Both are a part of larger practices. Kamath billed Medicare $8.2 million and received $3.2 million in payments, while Gealy billed $3.2 million and received slightly more than $2.5 million. Neither responded to phone calls seeking comment on Wednesday.
CMS spokesperson Rachel Maisler said the agency does not comment on specific doctors, but did not deny that the data gaps existed.
Those gaps appeared to play into the concerns of physician lobbying groups, which fought against the release of the data and warned Wednesday that the information may contain inaccuracies and conflicts.
"We believe that the broad data dump today by CMS has significant shortcomings regarding the accuracy and value of the medical services rendered by physicians,” said AMA President Ardis Dee Hoven, M.D. “Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences.”
The California Medical Association took a stance similar to that of the AMA.
“Our concern with the release of information today is that Medicare claims data is complex and the broad release of information without proper context can result in inaccurate conclusions and broad misinterpretation,” said CMA President Richard Thorp, M.D. “The hope is that physicians will be allowed to review and correct information prior to its release and that proper context will be given so as a complete understanding of the information does not mislead those digesting the data.”
CMA spokesperson Molly Weedn said late Wednesday that the organization had unearthed some inaccuracies in the data, but declined to provide specifics.
“We're just getting started,” she said.
