I am all for transparency when it comes to health care. So when Medicare announced a few weeks ago that it would begin to tell the public how much doctors are paid to treat Medicare patients, my first thought was "hooray." Another victory for consumer information.
Then I began to think about this in more depth. The Centers for Medicare and Medicaid Services (CMS), in response to a ruling in a federal case in Florida that doctors' interests do not trump the public interest, said it would begin releasing doctor payment data on a case-by-case basis. The agency added that they would respond to Freedom of Information requests but could not guarantee that every request would be filled.
It's not clear how the data will be presented. Will all the docs, say, in Casper, Wyoming, who have done knee surgeries be on some list with their payments revealed? Will all the doctors everywhere who've performed a particular procedure be listed in some gigantic database?
Doctors themselves are jittery about these potential disclosures. Ardis Dee Hoven, president of the American Medical Association, has urged Medicare to release such data only for the purpose of improving the quality of health care services and with "appropriate safeguards," whatever that means.
As a journalist, I see all kinds of possible stories emerging once enough data is available, and that may be a reason why journalists hailed the CMS announcement. Data can be used for exposés of the priciest doctors, or to identify outliers for particular services.
In some ways, I really don't care about the doctors' concerns. As a group, they've never been forthright about their incomes and have lobbied hard over the years to protect their bottom lines. Why should we expect anything different?
Still, I keep returning to the question: What will the data do for the average person? Can a person really use it to make decent health decisions? And will the release of payment information make a dent in Medicare spending? MedPage Today reported that in 2012 Medicare paid $69.6 billion to some 800,000 providers. That was only 12 percent of Medicare's overall fee-for-service spending. The real bucks to be saved are found in what Medicare pays hospitals.
I can see some Medicare patients using the payment data, especially if they are enrolled in Medicare Advantage. Given the cost-sharing features of these plans, knowing the prices of various services from different doctors would be very helpful.
It is less clear, however, that having access to Medicare physician payment information will be useful to someone who has one of those cheapie health insurance policies offered on the state exchanges – the ones that call for 30 percent or 50 percent coinsurance – since prices for Medicare patients may be different from what doctors charge commercially insured patients.
But we also run into that old problem: Price doesn't always equate with quality. At this point, we don't know how or if Medicare plans to couple its payment data with quality measures, if at all. As I reported in my last column on tiered-networks, officials from Independence Blue Cross said they couldn't use quality data for placing many doctors in their price tiers because there was no public database assessing the quality of specialists.
Then there's the problem of data overload. Patients are likely to shrug off payment data as just another set of numbers to consider in carrying out a very complex task. Many patients like their doctors and are loathe to blame them for the woes of the health care system. Most will think what doctors are paid by Medicare is just fine.
The attention showered on this potential data goldmine seems misplaced. While CMS is taking an important step towards payment/price transparency, the data collected is limited to Medicare. In addition, as I've noted many times before, the disclosures that may be the most useful are those from Medicare and insurance companies that tell people what services they received, the amount their insurer paid and, most importantly, how much they owe. We still have that confusing EOB problem! Until there's real transparency in things that really matter to patients, it's hard to declare a consumer victory.