Physicians, specialty groups warn released CMS data lacks context

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Many specialty groups, such as the American Medical Association (AMA), and individual physicians object to the federal government's release of data on doctors' Medicare payments.

The AMA repeatedly criticized the lack of context, and former AMA president Nancy Nielsen, Ph.D., M.D., echoed the sentiment in an interview with MedPage Today. The average visit cost was only $57, Nielsen noted. "That's important so that people don't think that every time they go to the doctor the doctor is making a fortune," she said. "You cannot call a plumber for $57."

"[P]atients don't understand my charges are not the same as what I am getting paid," South River, N.J., family physician Linda Girgis, M.D., told MedPage Today in an email.

"On paper, it looks like I have received many federal dollars, when in reality, I was working for an hourly wage and the institution got the money," commented June Persons, a Montana-based nurse practitioner.

Although the American Academy of Emergency Medicine supports the data's publication, President Mark Reiter, M.D., similarly told MedPage Today that context is key. "It's important for the public to understand these are revenues from Medicare, not earnings," he said. "Physicians still have to cover all their practice expenses out of these revenues."

"I'm concerned that people in the community will get the wrong idea of how these billings reflect doctors' income," John Welch, M.D., a Hastings, Neb.-based ophthalmologist who the Associated Press ranked number eight in its analysis of the physicians paid the most by Medicare, told the AP. "Instead of blaming us, they need to have a serious discussion with the drug companies about lowering the cost of these drugs. If they want us to stop taking care of patients, then tell us that--but don't blame us for costs."

"The money doesn't come to me," New Jersey pathologist Michael McGinnis, M.D., medical director for PLUS Diagnostics and number three in the analysis, told the Washington Post. "It goes to the company. It goes to PLUS Diagnostics."

"When a patient simply looks at raw data and does not have in front of them all of the various things that are applied in context to interpreting the data, are they in fact more prepared to make the right decision?" AMA President Ardis Dee Hoven, M.D., said, according to another MedPage Today article. "My answer to that is probably not, but they need to talk about it with their physician."

Releasing doctors' financial data could also facilitate fraud, Medical Group Management Association President Susan Turney, M.D., told Healthcare IT News. "Physicians should have had the opportunity to review the data before it was made publicly available in order to modify or appeal any inaccuracies," she said.

And some of the physicians who received the most Medicare payments raise questions about the appropriateness of certain Medicare reimbursement policies. Salomon Melgen, who received nearly $21 million in Medicare payments in 2012, and MIchigan oncologist Farid Fata, who received more than $10 million, are accused of over billing and fraud, FierceHealthPayerAntiFraud reports.

To learn more:
- here's the MedPage Today interview
- here's the first MedPage Today article
- here's the second MedPage Today article
- read the third MedPage Today article
- read the AP article
- read the Healthcare IT News article
- check out the Washington Post analysis

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