PHILADELPHIA, PA (June 9, 2014)There's much to learn from the recent release of unprecedented amounts of data from the nation's second largest health insurer, Medicare, but only if interpreted cautiously, write two doctors at Fox Chase Cancer Center in the June 9 online edition of the Annals of Internal Medicine.
In April, the Centers for Medicare and Medicaid Services (CMS) released the most detailed data in its history, related to $77 billion worth of physician billings to Medicare. In its analysis of the data, The New York Times showed that only a small percentage of healthcare providers usurp nearly one quarter of all federal payments. For instance, in 2012, more than $600 million went to just 100 doctors.
So what conclusions should be drawn from this analysis? Although high payments to a few individuals raise concerns that some doctors have billed more than they should, there's often much more to the story, say Fox Chase's Eric M. Horwitz, MD, Chair of the Department of Radiation Oncology, and David S. Weinberg, MD, MSc, Chair of the Department of Medicine.
Specifically, more or less payments from Medicare are not indicative of the quality of care a doctor provided, argue Horwitz and Weinberg. In fact, the more doctors perform a particular procedure, the better they should be at it. And the data only discuss the amount of care, not whether it was appropriate it's possible that many of these large expenses stemmed from therapies or tests that were entirely necessary. "Most important, Medicare annual payment figures provide no insight into whether the patient benefited from the treatment," the doctors say.
In some cases, add Horwitz and Weinberg, it makes total sense that certain physicians bill more to Medicare, since they specialize in conditions that affect the elderly, such as cancer, cataracts, and macular degeneration. "Wide variations invite thoughtful discussion of how best to allocate finite resources,"
|Contact: Diana Quattrone|
Fox Chase Cancer Center