This article originally appeared on ProPublica’s website.
The government’s new website on drug and device company ties to doctors will be incomplete and may be misleading – for now.
The government’s release today of a trove of data detailing drug and device companies’ payments to doctors has been widely hailed as a milestone for transparency. But it is also something else: a very limited window into the billions in industry spending. Before you dive in and search for a specific doctor, here are five caveats to keep in mind: Continue reading
One factor that makes health care costs difficult to manage is the system the federal government and health insurers use to decide how to pay physicians for the various services they deliver.
In an article in The Washington Post, “How a secretive panel uses data that distorts doctors pay,” journalists Peter Whoriskey and Dan Keating explain that a committee of the American Medical Association meets in private every year to develop values for most of the services doctors perform. The AMA is the chief lobbying group for doctors.
Read more about this secretive panel and the problems that Keating and Whoriskey identified wtih the process.
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.
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
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
(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.
AHCJ’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.
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
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
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
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.”
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