Blog | Tuesday, July 15, 2014

More sunshine on the Medicare data release

I wrote recently about the release of physician billing information by CMS and noted that news organizations had quickly provided tools to look-up individual physicians. Propublica, an “independent, non-profit newsroom that produces investigative journalism in the public interest” has gone one better. In keeping with their mission to “expose abuses of power and betrayals of the public trust … through the sustained spotlighting of wrongdoing” they recently posted a more powerful online tool for analyzing and viewing the CMS data along with a companion story of what they found by using it.

The tool allows a user to look up any physician who received Medicare payments in 2012 and learn which services he or she billed for, and how his or her billing patterns compare to the patterns for physicians in the same specialty and state. Other features, which are all explained on an instructional video on the site, allow users to see which physicians were most likely to have seen a patient before or after that patient saw the doctor in question, and to look for outliers by rank ordering doctors by services, payments and other parameters. It is easy to use and I almost felt like a voyeur as I clicked through the features. So much data, so easy to access! It was irresistible to look up people I know and peak into their practices, and I can easily imagine savvy patients (not to mention the Medicare Inspector General) doing the same.

Speaking of the IG, my fascination turned to disgust when I read the companion piece about some particularly glaring outliers. I know the data are not perfect. I know this is at best an incomplete picture of how anyone practices, but this was just gross. Coding 95% of your office visits as level 5? Seeing Medicare patients an average of 8 times a year and doing vascular ultrasounds and spirometry on every patient at office visit? Come on. Who can possibly look at that and say it may be justified on the basis of clinical acuity or patient characteristics? This is so beyond anything that is even imaginably justifiable, that it screams “churning” and fraud.

The sad truth is that the doctors practicing this way have been hiding in plain sight, and the these data not only indict them, but also point to regulators asleep at the switch, and a professional community that has failed to police itself.

What do you think?

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.