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Privacy or transparency: Maryland psychiatrists speculate on Medicare payments and their accessibility to the public


 

Despite protests from the American Medical Association, on Wednesday, April 9, the Obama administration made public payments to 880,000 Medicare providers. The data, released by the Centers for Medicare & Medicaid Services, include the clinician's name; specialty; address; and a breakdown of the number of patients who received each itemized service, the number of services rendered, the average amount billed per CPT code, and the average amount paid; along with the physician's total Medicare reimbursement for 2012. The data are easily accessible, and major newspapers have included look-up tools on their websites to allow for easy access to the data.

Through a discussion on the Maryland Psychiatric Society listserv, the opinions of several psychiatrists were solicited. From this, I learned that psychiatrists in my metro area have had mixed responses to the release of this information. Jesse Hellman, a psychiatrist in private practice in Towson, Md., notes: "This was a major privacy violation. Publishing the payments to individual physicians was a blunder. It should never have happened. Relevant data might have been released in another form."

Brian Crowley, a psychiatrist in practice in Washington, feels otherwise. "Personally, I'm in favor of the publication. It is of interest that most of the money goes to a few doctors, I believe, and may help planning. I believe the transparency is likely a good thing."

Roger Peele, a psychiatrist in Rockville, Md., agreed. "Even though misleading in some ways, and even though it might decrease the willingness of a few to be part of Medicare, it adds weight to the argument for a more rational payment system for physicians."

Robert Roca, vice president and medical director of Sheppard Pratt Health Systems added that he’d heard a journalist with expertise about this issue speaking on National Public Radio. "They don’t see this as a privacy issue. Their argument is that these are public dollars and that the public is entitled to know how and where they are spent. Unfortunately, the question of whether detailed information about payment of public dollars for other goods or services should be readily available to the public did not come up."

Steve Daviss, president of FUSE Health Strategies, had a lot to say about making the data public: "Put me in the 'transparency is good' camp. I see this less from a privacy of the doctor viewpoint, but rather from the perspectives of open government, and that this sort of data feedback mechanism is needed for proper homeostasis of our health care system.

"The U.S. spends twice as much per person on health care as any other country – double! – yet, we are not getting twice the health outcomes. When the CMS [Centers for Medicare & Medicaid Services] released this sort of data for hospitals, only then could we see the huge disparity in billing practices across the country. This sort of data about physicians will help demonstrate similar discrepancies, not just the 0.1% of physicians making millions on senior cataract surgery or whatever, but the shortages. There are many explanations for the odd data bits, which provide us a great opportunity to educate our patients and our policy makers.

"I don’t really see the danger," Dr. Daviss continued. "Where I do see the danger is in preventing people from understanding how much health care costs, where the money goes, and how to comparison shop. The next step (maybe it should have been the first) is to also share aggregate quality data, patient experience data, and comorbidity data. Then people will begin to connect the dots and have the information needed to make better health care decisions."

Laurie Orgel, a psychiatrist in private practice in Towson, countered, "I suppose we can look at this as a privacy issue, but there is the issue of relevance. What does it get anyone? Yes, there will be those of us who note the minority who get huge reimbursements, but I suspect that will just tarnish the rest of us rather than be understood as ‘a few outliers.’ Does this information really help planning?"

Kery Hummel, executive director of the Maryland Psychiatric Society, said, "I also wonder why some people have such considerable amounts and others such small amounts." He was quick to point out that the list included income earned for a psychiatrist, still listed at a Maryland address, who had moved out of state several years before.

Whether it's a violation of a doctor’s privacy to have the details of his practice and incomes easily accessible to the public, and whether this degree of transparency adds value when it comes to making health care more efficient with better outcomes, will be seen over time. In terms of capturing fraud, one might think that the CMS always had access to this data, and if it's an outlier for a physician to receive $21 million in Medicare dollars, then that should have been known without the need to make that information public. Notably, the data, even if completely correct, don’t tell the full picture of American health care dollars, as it doesn’t capture the practice habits of those who have opted out, or any transactions that are not provided through the Medicare program. The statistics, by definition, are skewed to reflect the practice habits of participating physicians who treat senior citizens and the disabled.

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