Doc Medicare payment data release may expose self-referral

The federal government could expose doctors who receive substantial payments from unnecessary tests and procedures when it releases doctors' Medicare payment data, according to Bloomberg Businessweek.

"A lot of people on Medicare will drop their coffee cups when they see how much their doctors are making," Jean Mitchell, a Georgetown University economist, told Businessweek. "People don't recognize that medicine is a business; the way you make money is by doing procedures. You don't make money telling people to eat right and exercise."

Some data, Mitchell said, will likely relate to self-referral--doctors referring patients for tests performed in their own office or at an affiliated clinic. Although federal law prohibits self-referral, the practice thrived over the last decade due to exemptions in the statute, according to Businessweek. Within procedure-heavy specialties, research shows doctors with a vested interest order far more procedures and tests than those who have no such financial stakes, according to the article. "The referring doctors get paid for doing nothing," said Mitchell. "For some doctors, [the data] is going to be potentially pretty damning."

Despite these concerns, the American Medical Association (AMA) told the Associated Press it will not fight the data's release, scheduled for Wednesday, although it continues to oppose the move. AMA President Ardis Dee Hoven, M.D., spoke out against the decision last Wednesday, saying the Centers for Medicare & Medicaid Services' "broad approach to releasing physician payment data will mislead the public into making inappropriate and potentially harmful treatment decisions and will result in unwarranted bias against physicians that can destroy careers."

Questions remain about the data's accessibility, according to Businessweek. The Department of Health & Human Services will release the data in bulk for download, along with summary Excel files, an agency spokesman said Friday, but officials are still figuring out how "to make these data easier for consumers to understand," according to the article.

To learn more:
- here's the Businessweek article
- read the AP article

Suggested Articles

Most healthcare organizations are lagging in awareness and preparedness for compliance with proposed interoperability rules, according to a survey.

Blue Cross and Blue Shield of North Carolina and Cambia Health Solutions have jointly decided to end their talks to enter a "strategic affiliation."

California health officials have released their first report on the price hikes drug companies sought to shield.