Tag Archives: doctors

Medicare payment data now available for individual states

Jeff Porter

About Jeff Porter

Jeff Porter is the special projects director for AHCJ and plays a lead role in planning conferences, workshops and other training events. He also leads the organization's data collection and data instruction efforts.

When the Centers for Medicare and Medicaid released payment data last month, health reporters paid attention. It allowed an unprecedented look at how $77 billion of public funds have been spent.

Now, AHCJ has made the data more accessible for its members. Members can follow this link to download Microsoft Excel files by state. The page includes links to the actual files, plus links to documentation, a rundown of caveats and tips, and descriptions of the each spreadsheet column.

The data covers payment information for individual doctors and other providers for Medicare Part B services delivered in 2012 – a total of 9,153,272 records in the original data file, totaling 1.7 GB. The file covers more than 880,000 physicians and other providers who received payments from Medicare.

The comprehensive file is too large for common desktop database software, so AHCJ took the extra step of breaking down the data by state and posting the files for download, along with some tips and caveats for reporters.

The new data provide a more detailed picture of how physicians practice in the Medicare program, and the payments they receive. The data contain information on health care professionals in all 50 states – plus the District of Columbia, U.S. territories and a handful in other countries. Because of privacy concerns, the government files exclude providers who seek reimbursement for services done for 10 or fewer patients.

With these files, it will be possible to conduct a wide range of analyses that compare thousands of different services and procedures provided, as well as payments received by individual health care providers.

Caution in order when tackling newly released Medicare data

Charles Ornstein

About Charles Ornstein

Charles Ornstein is a senior reporter with ProPublica in New York. The Pulitzer Prize-winning writer is a member and past president of the Association of Health Care Journalists' board of directors and a member of its Right to Know Committee.

AHCJ hosted a webcast about the CMS data, featuring several CMS officials and Charles Ornstein, a senior reporter at ProPublica and member of AHCJ’s board of directors.

The federal government is expected Wednesday to release data on the services provided by – and money paid to – 880,000 health professionals who take care of patients in the Medicare Part B program. For 35 years, this data has been off limits to the public – and now it will be publicly available for use by journalists, researchers and others.

While the data offers a huge array of stories, which could take weeks or months to report out, it also has some pitfalls. Here are six things to be aware of before you dig in:

Have a strategy for storing and opening the data. This data set is big. About 10 million rows, from what I hear. Because of that, you won’t be able to analyze it in Microsoft Excel and you might not be able to open it in Microsoft Access. You’ll want to upload it onto a data server and analyze it in a more powerful program such as SQL or SPSS. This could well serve as a barrier to entry for smaller news organizations. You may want to partner with an academic institution or another news outlet to analyze the data. Continue reading

CMS data should give reporters a plethora of new stories to cover

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology, Home Care Technology report and on HealthStyles Radio (WBAI-FM, NYC). She is a senior fellow at the Center for Health, Media & Policy at Hunter College, NYC, and a co-produces HealthStyles for WBAI-FM/Pacifica Radio.

As Charles Ornstein pointed out, the Centers for Medicare and Medicaid Services announced that it will release payment information for individual physicians in response to Freedom of Information Act requests, beginning in March. The move will increase transparency while still protecting the privacy of Medicare beneficiaries, according to a blog post by Jonathan Blum, principal deputy administrator.

According to a story in Modern Healthcare, the AMA has warned the Obama administration that it will be walking a thin line between balancing physician privacy rights with release of payment data – and that poor execution of the policy could lead to an unfair breach of confidentiality for providers and patients. Continue reading

Fight for access to Medicare payments to physicians nearly over

Charles Ornstein

About Charles Ornstein

Charles Ornstein is a senior reporter with ProPublica in New York. The Pulitzer Prize-winning writer is a member and past president of the Association of Health Care Journalists' board of directors and a member of its Right to Know Committee.

(Editor’s note: This is a revision of the original post, which is available on Ornstein’s Tumblr site.)

The Centers for Medicare and Medicaid Services (CMS) said yesterday that it will soon begin releasing data on payments to individual physicians in the Medicare program.

Why is this such a big deal?

Because it overturns a longstanding agency policy that for more than three decades had barred the release of this very information. And, it follows advocacy for greater transparency by numerous news organizations, including the Association of Health Care Journalists.

CMS-9-3-13-1AHCJ’s board of directors last September sent a letter of comment to CMS asserting the public’s interest in release of this information. “As long as patient confidentiality is protected, we see no reason why taxpayers should not know how individual physicians are spending public dollars,” said the letter, signed by AHCJ executive director Len Bruzzese.

Some background:

In 1979, a federal court in Florida granted an injunction that prohibited the U.S. Department of Health, Education and Welfare (the predecessor to the Department of Health and Human Services) from releasing data on how much physicians earned under the Medicare program.

A year later, the HEW department adopted a policy that stated, “the public interest in the Department’s disclosure of the amounts that had been paid to individual physicians under the Medicare program was not sufficient to compel disclosure under the Freedom of Information Act.” Continue reading

Three stories illuminate how doctors’ fees are established

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Most of the posts I do here have a take-home message tailored to the rollout of the health law: here’s something going on that you can take and write about in your community. So initially I didn’t write about three very good pieces about fee-setting for physician payments. But after thinking about it some more, I decided to draw them to your attention. They may not be all that easy to localize, but they do explain a lot about how doctors are paid, why specialists get so much more than generalists, and why the system is so broken. They are worth your time.

All three articles focus on something called RUC (rhymes with truck) – Relative Value Scale Update Committee, which is run by the American Medical Association and makes recommendations (almost all of which are accepted because there isn’t really a good alternative system) to Medicare about prices of specific physician services. The RUC is dominated by specialists, not primary care physicians, and it favors high-intensity procedures over cognitive medicine. The prices are set based on both the time and the complexity of a physician service. Putting in a stent has higher value than having a good long talk with a cardiac patient about diet, exercise and lifestyle, to come up with one simple example. Continue reading

Chicago members learn about changing end-of-life conversations

Carla K. Johnson

About Carla K. Johnson

Carla K. Johnson (@CarlaKJohnson) is a medical writer at The Associated Press and has covered health and medicine since 2001. She is a member of AHCJ's board of directors, serving as liaison to the association’s local chapters and leading the one in Chicago.

Julie Goldstein, M.D., Martha Twaddle, M.D., Mary Mulcahy, M.D., and Randi Belisomo (left to right) discussed end-of-life care at an AHCJ Chicago chapter event on June 11.

Photo: Carla K. JohnsonJulie Goldstein, M.D., Martha Twaddle, M.D., Mary Mulcahy, M.D., and Randi Belisomo (left to right) discussed end-of-life care at an AHCJ Chicago chapter event on June 11.

A series of chats between two women on side-by-side elliptical trainers at a health club led to the founding of a nonprofit organization dedicated to raising awareness about end-of-life care.

On one machine was Randi Belisomo, a WGN reporter in Chicago and now a member of AHCJ. Beside her was Northwestern University oncologist Mary Mulcahy, M.D., who had treated Belisomo’s husband, political reporter Carlos Hernandez Gomez, as he died of colon cancer at age 36.

Belisomo and Mulcahy told the Chicago chapter of AHCJ how they co-founded Life Matters Media to spread the word about the importance of planning ahead to make one’s wishes known about medical care and quality of life before one’s death.

“We like to take the stance there’s no right or wrong in end-of-life decision making,” Belisomo said. “There’s only decision making.” Continue reading

Medicare data shows dangerous prescribing habits, lack of oversight

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

ProPublica’s Tracy Weber, Charles Ornstein and Jennifer LaFleur, in an analysis of Medicare prescription records, found that “some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive,” with no attempt by the federal government to monitor or deter the practices.

“… officials at the Centers for Medicare and Medicaid Services say the job of monitoring prescribing falls to the private health plans that administer the program, not the government.”

Continue reading

All in the family: When medical experts disagree #ahcj13

Stephanie O'Neill

About Stephanie O'Neill

Stephanie O'Neill is a health care reporter at KPCC-Los Angeles. She is attending Health Journalism 2013 on an AHCJ-California Health Journalism Fellowship, which is supported by The California HealthCare Foundation.

Photo by Len BruzzeseJerome Groopman and Pamela Hartzband.

Oncologist Jerome Groopman and endocrinologist Pamela Hartzband both attended Ivy League medical schools. He went to Columbia. She went to Harvard. They both spent their residencies at Massachusetts General. They’re both Jewish. And they’re husband and wife.

But ask them their opinion on a particular medical treatment and you’re likely to get the opposite advice. Continue reading

Using data to track doctors’ referrals, relationships #ahcj13

Jason Hidalgo

About Jason Hidalgo

Jason Hidalgo is a business reporter at the Reno (Nev.) Gazette-Journal and a 2013-14 AHCJ Regional Health Journalism Fellow.

Fred Trotter

Photo by Pia ChristensenFred Trotter.

Going online is usually a great way to waste time or — for adventurous social media users — get in trouble.

For resourceful journalists, however, the Internet is a treasure trove of information that can be invaluable for reporting. These include providing access to open-source tools such as DocGraphs, which can provide crucial data that may not easily be available anywhere else.

A crowdfunded project from open source developer Not Only Dev, DocGraphs aims to shed light on the relationships between various medical providers, and make that information more accessible to the public. Examples include which doctors and medical centers a specific doctor refers patients to or which laboratories a physician group tends to use. Continue reading

Member uses data to track doctors’ referrals; AHCJ members get a first look

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

AHCJ member Fred Trotter publicly unveiled a major data set last week that could reshape how journalists report on medical professionals. At the Strata Rx conference in San Francisco, Trotter showed off data he received from the U.S. Centers for Medicare and Medicaid Services that could show the relationships among physicians, as well as their referral patterns.

fred-trotter

Fred Trotter has agreed to let AHCJ members have access to his development website so they can look up specific doctors. To access it, click here and login to the AHCJ site.

Trotter plans to release the full data set and the search tool to the public at a later date (see below). Trotter answered some questions from AHCJ President Charles Ornstein:

Q. Tell us about the data set you just unveiled.

A. This is the social graph of medicine. It is the referral patterns for most of the doctors, hospitals and labs in the country, based on a FOIA request for Medicare data. For any given physician in the United States, there is a good chance that this data set reveals what other doctors, hospitals and labs they typically work with.

Q. How could it be useful for journalists?

A. Using the data, journalists will be able to figure out “who to gumshoe” for health care stories.

Some ideas:

●     You have a “bad doctor” story. This works for crime, fraud, etc. Who was referring patients to that doctor, what hospital was he or she working with? At the least, the people you identify would be interesting to interview. At worst, these people may be co-conspirators.

●     Who are the best doctors in your city? Who is the best local resource to interview about cardiology, neurology, etc. Specialists who have lots of inbound referrals from different doctors implicitly have the respect of other doctors in the community.

●     By grouping doctors by hospital referrals, it will be possible to see which ones are “aligned” with different hospitals. It is also possible to measure how exclusive this affiliation is. Most local health care reporters have an intuition of how the local health care market operates, but this will provide specific details.

●     By working with data scientists we can make lots and lots of pretty diagrams to support journalistic assertions. Continue reading