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James D. Felsen: Medicare data release a political sham

By By James D. Felsen

Kudos to the Gazette. They quickly and fairly demonstrated in an April 11 article that the recent release of Medicare physician payment data can only be validly interpreted by analyzing additional data within the context of each individual physician’s practice. The federal Centers for Medicare and Medicaid Services knew this. However, it released the data anyway without an opportunity for individual physicians to review and challenge its accuracy and relevance. Why?

Instead, it issued a lukewarm warning the data could be misinterpreted but highlighted and claimed how valuable it would be in assisting the public to detect and report fraud and abuse, as well as identify sources of high quality, cost-effective medical care. Hogwash! But, again, why?

The data contains no measures of quality, patient case severity mix, and intensity of care. Therefore, it is useless as a measure of quality and cost-effectiveness and the release should have clearly stated this.

As to detecting and reporting physician fraud and abuse, the claim is equally ludicrous. John, a local electrician, and Linda, a local librarian, are going to effectively analyze and use this data to detect and report alleged fraud? Meanwhile, CMS, who has had this data for years -- with its stable of lawyers, analysts and accountants, as well as auditors who frequently visit physician offices and assiduously review claims data – is unable to identify and arrest such alleged fraud? How does that work? I wish it did because it means we could reduce the size of the CMS bureaucracy by half.

The release of the data per se is not the issue. It is the manner in which it was released, promising great benefits for patients and the public, with little discussion of its possible inaccuracies and virtual uselessness if not analyzed in the context of other information for each practitioner.

The vast majority of the press parroted the CMS message about the huge contribution the release will have upon containing fraud and abuse and promoting receipt of higher quality and cost-effective care. The Raleigh (NC) News and Observer went further noting the data “show why we need more government in health care.”

The American Medical Association and others outlined many additional factors that make the data impossible to interpret in its raw form in order to infer anything about the quality, cost-effectiveness, appropriateness, value, legality, and ethical nature of any individual physician practice. These releases received little press attention. What should a physician do who wishes to maintain a good reputation?

The only definitive solution would be for the physician to greatly reduce or eliminate Medicare and Medicaid patients in his or her practice. That would establish him or her as an ethical physician who practices high quality, cost-effective care, as evidenced by the fact that they received $0.00 from the federal government. Unfortunately, that would adversely affect access to care for many Americans. I doubt that is why CMS released the data in the manner they did.

I can only conclude the reason “why” CMS acted in such a reckless and ruthless manner was they were searching for a scapegoat to blame if they continued to demonstrate a lack of competency and capacity to limit escalating federal health care expenditures, fraud and sub-standard care, which in turn could threaten the survival and growth of their bureaucratic fiefdom. Rile up the public to attack the doctors rather than the responsible politicians and bureaucrats. That is sorry!

James D. Felsen, of Great Cacapon, is a retired public health physician.


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