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AMA CEO Dr. James Madara
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AMA protests Medicare data release


By Joe Carlson
Posted: May 15, 2014 - 3:15 pm ET
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The mass release of data last month on how Medicare paid 880,000 doctors in 2012 has been hailed as a transparency goldmine in the media, but doctors say the information has produced a raft of “sensationalist” stories that have misinformed the public.

It's not the first time this argument has been aired. In the late 1970s, the American Medical Association accused Medicare officials of publishing flawed data on doctor payments that ended in public misinformation. Those complaints culminated in a lawsuit that ended with a court-imposed ban on publishing doctor-payment data that stood for more than 30 years.

This time around, the AMA says its goal is not to stand in the way of transparency, and no new lawsuit is in the works, an AMA official told Modern Healthcare.

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But in a letter to Medicare officials Thursday, AMA CEO Dr. James Madara laid out several specific complaints with the data and renewed doctors' requests to be able to fact-check and change the payment data before its public release.

“Untrained observers are using the data to make flawed regional, specialty or other comparisons that CMS should do more to discourage,” Madara told Medicare officials in the letter. “The recently released data have brought a series of sensationalist news stories, the majority of which inaccurately reported on the data, confused the public, and in some cases may have encouraged patients to make care changes that were not in their best interest.”

The AMA didn't highlight any specific reports, but many media accounts have used the Medicare data to draw attention to physicians whose practice patterns raise questions about the accuracy of their bills or the appropriateness of their care. Reports in the New York Times and the Wall Street Journal spotlighted how a fraction of doctors account for an outsized share of Medicare payments. CBS News reported that a concentration of high-risk spinal-fusion surgeries by a handful of doctors indicates some physicians may not be following commonly accepted medical guidelines. Just today, ProPublica identified 1,800 doctors who billed Medicare for the most expensive type of office visit at least 90% of the time in 2012.

The potential for such investigative news stories was a significant factor in the decision to publish the data on April 9. Jonathan Blum, CMS' principal deputy administrator, wrote in a letter to the AMA that previous physician-identifiable Medicare payment data have led to stories in the Wall Street Journal that identified fraud, waste and abuse of Medicare dollars.

“The department concluded that the data to be released would assist the public's understanding of Medicare fraud, waste, and abuse, as well as shed light on payments to physicians for services furnished to Medicare beneficiaries,” Blum told Madara in the April 2 letter.

But Madara's May 15 letter to Medicare officials says the dataset contains a number of critical flaws.

For example, the CMS' decision to exclude any services for which a doctor saw fewer than 11 patients meant that large swaths of potentially meaningful data were struck. The data also lump physician payments for expensive drugs into doctors' overall payments, inflating expenses for specialties with high drug costs, like ophthalmology and oncology. Finally, some doctors in group practices or hospitals appear to have inflated bills because their entire practice submits bills under a single provider number.

Rather than banning release of the data again, AMA officials say doctors should be given the right to correct the information before its publication—even though the doctors themselves submitted the data to Medicare that they now want to correct.

“We do not accept the argument that all errors in the database were put there by physicians. Nor do we agree that unintentional administrative errors by physicians justify the deliberate release of inaccurate information that misleads patients and reduces trust in their physician,” Madara wrote.

CMS officials acknowledged receiving the letter, but declined to issue a public response.

Follow Joe Carlson on Twitter: @MHJCarlson


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