Sunday, April 13, 2014

Attention Physicians, Your Government Just Flipped You The Bird

According to a 2012 study by Jackson Healthcare, the percentage rate of U.S. Physician compensation is among the lowest of western nations.  In 2011 physician's salaries compromised 8.6 percent of the nations total health care costs.  This is in comparison to 15 percent in Germany, 11 percent in France, and 11.6 percent in Australia.  Detractors point to the fact that although the percentages speak for themselves, if you look at the total number of dollars (Per capita health spending in the U.S. is double that of the average for the twelve other OECD countries), physicians are still compensated quite well.  Either way, in our bloated costly system, physician services are comparatively already discounted.

So it was with great pomp and circumstances, as well as consternation from various physician sources, that the government released data for all payments made by medicare to physicians in the year 2012.   Lauded as a win for transparency, the administration argued that making such information public would lead to a reduction in fraud, greater research into healthcare costs, and empower citizen investigators to crack the code of our overwrought system.

In reality, the so called "data dump" was exactly just that.  Refuse.  The information didn't account for the percentage of each physicians practice as medicare vs private insurance.  There was no recognition of pass through costs (medications, chemotherapy, etc.).  There was no adjustment for range or severity of illness of each physicians patient population.

Besides physicians, it is unclear that this information will really interest anyone.  The government and the FEDs already know who are the largest medicare billers, they were privy to the information previously.  The public is so overwhelmed with the ACA, surgical report cards, physicians rating sites, and the like, it is unclear that they will take the time or have the expertise to actually interpret the data.  Previous studies suggest that patients could give a hoot about such information.  And even if they could, finding a doctor who takes their insurance and hasn't been narrowed out of a network is hard enough.

I can assume that the only real reasoning to release such information was to send physicians a clear and unmistakable message.  We are being told not so subtly that we are being watched:

Get on board with what is happening, or there will be consequences.

That's right.  Our government just flipped us the bird.


Anonymous said...

I understand where you're coming from, but when you're paid with public money the public gets to know how much public money you're paid. It's a basic principle of good governance that applies to teachers, police officers, public university employees (including professors), politicians, public attorneys, and so on... Virtually all of these are searchable online.

Become a high ranking federal employee, and you get to fill out forms each year disclosing all your financial details (stocks, bonds, real estate, income, savings, gifts, etc..). These are ~28,000 of these, all public record, not online yet but it's only a matter of time (law passed, then delayed a bit).

If you want to accept public money, expect it to be public knowledge. If you want to keep your finances private, don't accept public money.

Medicare payments to physicians aren't being singled out, they're just being 'invited' to join the party.

Greg Matthews said...

Jordan: That's one interpretation of the "data dump." And I will grant you this - you are positioned like few others in the country to make this kind of judgment call. Unlike me, you've been on the frontlines with Medicare for years.
That's probably what allows me to take a more optimistic view. The "data dump" has invited the public into the data. Most people are going to look up their doc's reimbursement level, shrug, and move along. However, there are a lot of us who want to go deeper. We want to really understand what's here - and what isn't. It would be foolhardy to jump to conclusions based on the very limited picture we've been given. BUT. People like my colleagues and I are now in a position to ask questions we never could before. We're in a position to ask the government for specific data and resources to answer those questions. And we're able to work with members of the whole health ecosystem to try and solve some of the problems that have confounded us for a generation (at least) - because many of those problems were caused by the complete and utter lack of transparency in our system.
As I said: The odds of your being right in this matter are very high. Much higher than any kind of speculation I could make. But even if the government had ill intent behind their release of the data, there are now a thousand times more of us who are armed to demand more. Data wants to be free - and this first step feels like a big one to me.