By Garrett Hyman, MD, MPH
|
An article in today's NY Times
applauds the public release of Medicare data on provider payments (http://www.nytimes.com/2014/04/09/business/sliver-of-medicare-doctors-get-big-share-of-payouts.html).
The authors, Reed Abelson and Sarah Cohen, state, "While total
Medicare spending - including hospitals, doctors and drugs - is approaching
$600 billion a year, payments to doctors have long been shrouded in
secrecy." Sounds a lot like the start of a suspense novel. One
might imagine these journalists have uncovered a clue that might lead to the
big arrest that makes our nation safer from the epidemic of corrupt and opportunistic
physicians -- like an episode of "CSI: CDU (aka Corrupt Doctors
Unit)" -- as if this group of highly motivated and intelligent, type-A,
over-educated, devoted, hard-working, do-gooders is prone to acts of
mal-intent. Follow the money, and you will see the trail ends in your
doctor's wallet -- is the obvious message of this article.
The implication is that this now
open-source information about the Medicare earnings of your doctor will finally
provide you with critical financial information that will allow you to make
more informed healthcare choices. Specifically, you learn what your
doctor bills and what your doctor is paid, and the numbers of procedures your
doctor performed in 2012 on Medicare patients. Then with this data you
decide whether or not, for you, your physician is the most appropriate.
So let's try it out....using my Medicare payment data as an
example.....say you're a 35 year old male Microsoft employee and avid soccer
player with knee pain....you search the database and find that I've performed
30 'Arthrocentesis, aspiration and/or injection......large joint...including
the knee' on 18 Medicare patients, for which I charged an average of $195 per
procedure, and was reimbursed on average $57.
Alright now, we have the data --
let's be deliberate, methodical and purposeful, and logically sort through
these numbers to make an informed healthcare decision. Can we relate this
to healthcare quality? No. Outcomes? No. Efficiency?
No. How can the healthcare consumer make use of this data? I
don't know. Now, should you be a healthcare insurer looking to identify
physicians that perform higher numbers of procedures so that you can refuse
admission to, or drop a physician from your panel, well then this data may come
in handy. There's a way to increase corporate profits! Never mind
that, said physician, may be THE regional expert in restoring function to
patients with chronic musculoskeletal problems with office-based and
cost-effective approaches, specifically using targeted injection procedures,
thereby helping these patients avoid a more costly surgery. Where does
the Medicare payments data tell you this important information? It
doesn't.
What should it cost to manage the
knee pain of a 35 year old soccer player? The answer -- it depends.
As you might expect, not all knees and not all persons are created equal.
I won't attempt herein to go into all of the potential causes of knee
pain in an active 35 year old -- that's a treatise to itself -- but rest
assured, there are many unique causes. In fact, it is just this unique
variation that creates the need for...you guessed it...dedicated, expert
healthcare providers.
I have no idea whatsoever how to
make this data useful for either the 35 year old soccer athlete or the 80 year
old masters tennis player with knee pain.
I'm an experienced specialist
physician, and I can't follow the logic. Can you?
Interestingly, the article authors
did find a physician who can make use of this data; only he no longer practices
medicine. They quote a physician turned venture capitalist, Bob Kocher,
who says "This is actually the most useful dataset that Medicare has ever
released." They also note that Dr. Kocher formally served in the
Obama administration before parlaying his political influence into a plum job.
Now Dr. Kocher diagnoses more lucrative ways to make a living rather than
treating patients. What irony in the authors' choice to support their
narrative of the corrupt physician (and to be clear, I do not, at all, fault
any enterprising physician who elects to leave medicine to purposefully pursue
a profit)! Dr. Kocher is correct in one important respect -- this will be
the most useful dataset ever released by Medicare for health insurers and for
industry who can then use this data to select out specific physicians for their
proclivity to perform procedures. For example, the pharmaceutical company
that makes a drug or device that is delivered via joint injection would love to
know that I perform twice the number of joint injections compared to Dr. Smith
down the street -- much easier to target their marketing directly to me!
NY Times columnists Abelson and
Cohen paint a decidedly grim picture of the financial practices of American
physicians who participate in Medicare. They go on to relate, per a NY
Times analysis of the data, that "about 2 percent of doctors account for
about $15 billion in Medicare payments, roughly a quarter of the total."
The article notes that "the American Medical Association and others
have blocked the release of information (for decades)." How
incredibly devious and unscrupulous of these medical-mafioso! How the
plot thickens as we see that it is not only individual doctors but also organized
medicine is 'on-the-take.'
This, in truth, is a precautionary
tale of misguided though perhaps well-intended persons of influence (i.e.
government and the media) who have it all wrong, but have the influence to
widely spread a fallacy and in so doing generate strong negative popular
opinions about the individuals sworn to uphold our nation's health. Go
ahead, hate your doctor(s). And when your doctor decides to turn in his
stethoscope for a consulting job or a stockbroker license, be sure to ingratiate
yourself with your new care provider, likely a physician assistant or nurse
practitioner, because it's going to be hard to get an appointment , and they
work on the clock!
Go ahead and make this government
financial data transparent. I'm very comfortable with financial
transparency. (I've cut and pasted my personal data below for all
readers)
And so, while we know the villain,
the heroes in this story include, "fraud investigators, health insurance
plans, researchers," and of course, the NY Times -- they will "spend
weeks poring over the information about how many tests were ordered and
procedures performed for every provider who received Medicare payments under
Part B." They've clearly figured out the conundrum of skyrocketing
healthcare costs. It was the doctors all along! Uh, no.
Physician earnings do represent a significant piece of total healthcare
costs. But this piece is approximately 8% of total healthcare costs in
the USA (see http://lakewass.blogspot.mx/2014/02/meet-expert-brian-white-do-particular.html for
a more detailed discussion) -- a significant sum of money, yet even if we
eliminated all payments to physicians, clearly we would make little progress in
controlling overall costs.
And think about how backwards it is
that physician compensation makes up such a SMALL piece of healthcare spending.
We should pay our physicians handsomely, particularly those that provide
exceptional care. In many other areas of life we are more than willing to
pay top dollar for the best services or items. For example, Nordstrom's
has built their business around providing the very best customer service
experience in their industry -- their prices are higher than Macy's and JC
Penny, yet discriminating customers are more than willing to pay extra because
they trust in Nordstrom's satisfaction guarantee and fabulous return policy.
I know that when it comes to a dining, hotel, or other hospitality experience,
I prize excellent service above all else. I will pay a premium for
excellent service.
I just had the good fortune of
spending several days at a resort in Mexico, Las Ventanas Al Paraiso (LVP).
The staff essentially redefined for me and my wife the notion of "5
Star Customer Service." Our previous experiences with top notch
hospitality service were at the hands of the Ritz Carlton and the Four Seasons.
But the LVP team sets the gold standard. They are always professional,
deliberate in their service, and they clearly take pride in everything they do,
from setting your lounge chair in the shade, to expertly preparing your turn
down service which includes, as you desire, a warm drawn jacuzzi bath.
The embody hospitality in its truest form. The word,
"no," seems not in their lexicon. A frown may appear across the
face of an LVP team member only in the event they cannot fulfill a promise or
satisfy the whim of a guest. When our romantic custom beach-side theater
DVD movie event hit a glitch (the last 30 mins of the movie wouldn't play), the
team worked hard to find an immediate solution, and when they couldn't, they
apologized profusely for days, and then surprised us with an in-room theater
with an HD projector, bottle of champagne, and all the popcorn, candy, and
chocolates that one could wish for. They constantly are checking in; for
example, if you desire a shaded lounge chair, the pool attendant literally
follows the sun for you, making regular adjustments to your shade-providing
umbrella. They run, not walk, to provide assistance when you make a solo
attempt to adjust the angle of the head of your lounge chair. The LVP
staff, on the whole, behaves as if every team member is an owner of the
business.
We need medical doctors who focus on
patients, not healthcare systems.
And so how does this freshly
available Medicare financial data relate to your healthcare goals? Now
you know.
Results: 1 health care
provider named “Hyman” in 98004
Garrett Hyman tOTAL
REIMBURSED
1632 116th Ave Ne,
Bellevue, WA BY MEDICARE IN 2012
Physical Medicine and Rehabilitation $61,801
SERVICE
|
PATIENTS
|
TIMES
PERFORMED |
AVG.
BILLED |
AVG.
REIMBURSED |
18
|
30
|
$195
|
$57
|
|
27
|
34
|
$660
|
$111
|
|
23
|
30
|
$175
|
$25
|
|
26
|
93
|
$125
|
$57
|
|
18
|
19
|
$315
|
$77
|
|
39
|
39
|
$220
|
$90
|
|
73
|
73
|
$320
|
$136
|
|
61
|
80
|
$155
|
$60
|
|
91
|
170
|
$200
|
$89
|
|
26
|
147
|
$125
|
$51
|
|
20
|
31
|
$325
|
$180
|
|
19
|
21
|
$275
|
$110
|
Source: The information presented here is from
a database released by the Centers for Medicare and Medicaid Services. The
database excluded, for privacy reasons, any procedures that a doctor performed
on 11 or fewer patients. The total reimbursements for each doctor does not
include those procedures either. Results shown above include only the
individuals like doctors, nurses or technicians but not organizations like
Walgreens. While some providers could have multiple offices, the address shown
is the main address indicated in the database. Descriptions of the procedures
are from the American Medical Association.© 2014 The
New York Times Company
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