I Made HOW Much ?!?!

This past week CMS released Provider Utilization and Payment Data: information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. In case you weren’t following along, there has been quite a bit of controversy over the data release, including from both the American Medical Association and the Medical Group Practice Association.

Donald W. Fisher, Ph.D, MGMA President & CEO:
MGMA is troubled about the potential for unintended consequences as a result of the release of this type of data and the effect it may have on Medicare beneficiaries. This release could result in patients making decisions about their care based on faulty assumptions about physicians. Claims data are not a proxy for quality, especially when provided in isolation, from a single payer.
MGMA is also concerned about the impact on physician privacy, as releasing physician’s personal financial data and National Provider Identifier (NPI) information could make providers susceptible to fraud. Physicians should have had the opportunity to review the data before it was made publicly available in order to modify or appeal any inaccuracies.

Ardis Dee Hoven, MD, President of the AMA:
Thoughtful observers concluded long ago that payments or costs were not the only metric to evaluate medical care. Quality, value and outcomes are critical yardsticks for patients. The information released by CMS will not allow patients or payers to draw meaningful conclusions about the value or quality of care.The AMA is disappointed that CMS did not include reasonable safeguards that would help the public understand the limitations of this data.

Back in February of 2013 I wrote, Pick a Price – Any Price, describing how and why healthcare provider pricing is typically both misleading while at the same time meaningless. But the focus then and there was on hospitals. People in general are a lot more envious of other people than they are buildings and groups of people working in those buildings. Thus you can easily understand why there is concern over public perceptions – particularly when those perceptions are likely to be different than reality in most instances because of not understanding how to interpret the data.

Theoretically, I weigh this concern against a belief that in most cases more information is better than less.  Obvious exceptions include issues of personal privacy and national security. Transparency and accountability should be hallmark pursuits of the Medicare system. And I think most physicians are in favor of sharing data that helps empower the patient to make more informed healthcare decisions.

It is not at all clear the data released last week will be able to do that any time soon. In fact, the arguments positing the data’s release will do more damage than good are persuasive. These include a lack of any data on quality; inability to track actual service levels to individuals providing those services; misunderstanding of charges versus payment; inability to risk adjust for patients treated; no adjustments for site of service differences; discrepancies caused by changes in billing codes; and – most importantly – no way of knowing how much reimbursement the physician uses to cover overhead costs, which is required in order to determine real income.

So on balance I have to side with the physician groups on this one. CMS made a very poor decision to release the data, as-is, without any real thought about releasing it with all of the disclaimers addressing the issues and concerns described above. I hesitate to say it – but I say what I think – this sure feels like another backdoor attempt to promote victimization at the expense of disinformation.


Big Data Meets the Value Paradigm

VDO-Option3FlatA little over a year ago I shared a post on healthcare pricing: Pick A Price, Any Price. I wrote about the challenges, difficulties and consequences associated with the frustrating disconnect between hospital charges and the actual costs of proving care in those hospitals. At the time I also referenced the work of Michael Porter and Robert Kaplan that was published in the Harvard Business Review article, How to Solve the Cost Crisis in Healthcare.

I am excited to share with you research inspired by that article that was recently completed at the University of Utah, spearheaded by Dr. Vivian Lee, the senior vice president for health sciences and Dean of the University of Utah School of Medicine. Highlights of the research were published in the article, Hospitals Are In the Hot Seat, on the University of Health Sciences’ Algorithms for Innovation web site.

In a nutshell, colleagues representing several industry disciplines worked together to explore how harnessing Big Data and applied research might help empower patients and healthcare providers with more timely, more reliable – and most importantly, most understandable cost information and how costs compare to care received and outcomes achieved.

We’re all familiar with Peter Drucker’s challenge that, “if you can’t measure it, you can’t manage it.” Though less famous but probably more meaningful – or at least pragmatic – was Drucker’s quote that, “what’s measured improves.” Historically for healthcare trying to measure, apportion and determine meaningful costs at a granular enough level where that information has timely and impactful use has been elusive.

Here’s hoping this work is another step in the right direction.




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