Experts explain merits and shortcomings of Medicare data release
Two new commentaries in Annals of Internal Medicine discuss the significance of data released in April by the Centers for Medicare and Medicaid Services (CMS) on $77 million in physician billings to Medicare Part B, which covers services delivered to seniors and the disabled. Data on the treatments performed and payments made to more than 880,000 health care providers was released to the public in response to a Freedom of Information request made by the Wall Street Journal.
In the first commentary, Gail R. Wilensky, Ph.D., senior fellow at project HOPE and a former administrator for CMS, writes that the data released may be helpful in identifying fraud cases and can also further understanding of variation in health care and spending. However, Dr. Wilensky points out that missing data may lead to misinterpretation. For example, data on physician procedure volume that could help patients determine which doctors may be best for treating their medical conditions is incomplete because it does not include procedures covered by Medicaid or private insurers. In addition, the data is void of any quality metrics. Despite concerns in the medical community, Dr. Wilensky concludes that transparency in pricing and quality and health care is here to stay and suggests that physicians groups take the initiative to develop useful and accurate ways to report information.
In the second commentary, Eric M. Horwitz, MD, and David S. Weinberg, MD, MSc from the Departments of Radiation Oncology and Medicine at Fox Chase Cancer Center in Philadelphia express concern about the data released by CMS because they say it lacks meaningful context. Therefore, the authors caution against evaluating the data without a deeper understanding of what the data can and cannot reveal. For example, the figures provided by CMS do not explain how physicians made treatment decisions, the number of patients seen outside of Medicare, drug costs, lab services used, etc. One thing the figures do reveal is a huge regional variation in costs of care. The authors suggest that these Medicare data are an important step towards the transparency needed to enable thoughtful analyses of variations in health care and its costs but caution that careless evaluation of the data will hinder, not promote, efforts to improve health care value.