Medicare Data Fight Continues – Fedblog

Medical Privacy, and Medical Identity Theft is a HUGE issue, which is not being spoken about. Most people dont pull MIB’s often enough, I pull mine as often as I pull my credit. MediBid is 100% private, and htis is of paramount importance

Medicare Data Fight Continues – Fedblog.

The Health and Human Services Department on Dec. 5 issued a final rule that for the first time opens up its massive, decades-old database of Medicare claims to the public, under certain conditions. But to some audiences the rule was notable for what it did not address.

As called for by the Affordable Care Act, the rule from the Centers for Medicare and Medicaid Services “gives qualified organizations, like employers and consumer groups, access to data that can help them identify high-quality health care providers or create online tools to help consumers make educated health care choices,” an HHS statement said. “Information that could identify specific patients, however, will not be publicly released and strong penalties will be in place for any misuse of data.”

Wall Street Journal reporter John Carreyrou, however, reported the rule as “an abrupt policy change” and pointed out that it mentions nothing about the lawsuit filed by his newspaper’s parent company last January. Dow Jones and Co. is seeking to overturn a 1979 court ruling sought by the American Medical Association blocking media access to the Medicare database. The Journal has published a series of articles on fraud by individual physicians after obtaining access to only a portion of the database.

Also unaffected is a Senate bill, introduced in April by Ron Wyden, R-Ore., and Chuck Grassley, R-Iowa, that also would overturn the injunction and open the database more widely. “The final rule does not affect the WSJ lawsuit and the Wyden-Grassley bill,” said CMS spokeswoman Carolina Fortin-Garcia. “It is a specific program to release Medicare data to `qualified entities’ for them to create performance reports on providers and suppliers.”

Ashley Huston, a spokeswoman for Dow Jones, told Government Executive: “We are in the process of reviewing the regulations to determine what impact they may have on our action.”

A spokeswoman for Grassley said the legislation is “with the FBI and Justice Department for comment. Sen. Wyden called a member meeting with Sen. Grassley a couple of months ago. The outcome was that some members wanted to make sure there was no interference with law enforcement in making the information public.”
AMA President Peter W. Carmel, M.D., issued a statement saying the doctors group
“supports the use of accurate physician data when it improves quality of care for patients, but we are concerned that CMS’ easing of some requirements for receiving Medicare data could result in the distribution of physician performance reports that are inaccurate and not meaningful for patients or physicians.”

So the final rule is not the final story.

4 responses

I’m having trouble figuring out how one is supposed to judge “quality” of care from claims data. I strongly believe it can NOT be done. The concept makes no sense at all. Some physicians do NO hospital work, while others in the same specialty do extensive hospital consulting and care. Looking at the percentage of hospital care versus office care will tell you nothing about how well the office patients are cared for. Some physicians deal with a more severely ill population of patients or deal with their patients in more depth by doing more counseling. They will naturally have a higher percentage of “higher level” claims. Looking at the ratio of 99214 visits to 99213 visits, for example, will tell you nothing about quality of care. Some physicians elected not to submit “quality indicator” data to Medicare, because the payoff in “bonus” was not enough to justify the effort. I submitted numerous quality indicator data on my diabetes patients in 2008 and received NOTHING for the effort, so stopped bothering. This had no influence on the quality of the care I delivered.

The quality measures they refer to are more like a “pay for conformance” than anything related to real quality. Bean counters cant really quantify “quality” in medicine, other than re-admission rates, 99213 vs 9914 etc

The whole concept of evaluating performance, whether of a teacher or of a physician is absurd. You can measure how fast an athlete runs a race, but you can’t measure “quality” of a professional’s performance. There are simply too many variables at work. Apples and oranges, and all that.

The feeble attempts of the managed care plans so far are completely off the mark. Example: Blue Cross counted every patient (including PCOS and pre-diabetic subjects) I had placed on metformin as having diabetes mellitus and try to reduce my ‘blue’ rating because I had not done A1c testing and microalbumins in these folks with fasting glucoses of 90-105. Starting metformin early in the course of the disease that eventually turns into diabetes is now considered highly advisable, but I was 10 years ahead of that curve. Didn’t help my “rating” however, and I had to write a complaining letter listing all their errors to secure the proper rating.

Both Ralph and Larry are correct. In fact, measuring “quality” is potentially harmful to the health of the patient. eg. administering beta blockers within one hour of admission for myocardial ischemia worsens outcomes in those patients that have unrecognized heart failure. Arbitrary goals for glucosylated hemoglobin increase the risk of hypoglycemic spells ( a potentially fatal complication of diabetes). In Britain, doctors payment is based partially on how many patients that they start on statin meds. What of the dissenters and innovators that think statins are more dangerous than their meager to non-existent benefits for most of the population?( A view that I believe to be correct and yet in Britain, I would be penalized for it.) “Quality” is the path to tick -box medicine. At the risk of sounding arrogant, there are far to many doctors that do not think and will be happy with this type of medicine. Success will be cranking patients through in four minute visits and getting all of the “quality” measures taken care of while neglecting the patient.

Leave a Reply


Be sure to include your first and last name.

If you don't have one, no problem! Just leave this blank.