What a day it was for medical news. After much legal wrangling, specifically by the Wall Street Journal, the Centers for Medicare and Medicaid Services (CMS) released detailed data on payments to 825,000 US physicians in 2012. It was called a “data dump.”
Wow. Was it ever.
The story was front page news in US newspapers. Social media amplified the conversation. The WSJ featured an interactive tool that allows anyone to look up a doctor, and see exactly what Medicare payments he or she received in 2012.
I don’t like using the modifier “granular” (it sounds so academic) but this is indeed granular data. You can see codes, and numbers of procedures, and dollars, and then compare by specialty and region. You can see a lot.
In the doctor’s lounge today, I showed a number of unbelievers that this was possible. Soon, a small group gathered around a computer. “Hey, look up my numbers.” Once I did, the looks on their faces suggested high levels of neural activity. “How did that guy get such high numbers? What do you mean I only got that little? Oh…look at him up there.”
This, my friends, is a big moment. It’s provocative for many reasons:
1. A very small group of doctors were paid enormous amounts of money. Inequity is a hot topic these days.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
2. Certain specialties dominate. This dares us to compare the value of organ systems. Is the heart more important than the eyes or bones? What about my numbers versus my wife’s? Is relieving symptoms of AF that much better for humanity than relieving suffering at end of life? For that matter, what’s the value of responding in the middle of the night? The payments to general surgeons stand out. Geez–those folks look underpaid.
3. The ability to compare payments within regions and specialty tempts us to make judgements about variability in care. Should two doctors in the same region and same specialty vary by that much? Such disparity might suggest someone is not practicing evidence-based medicine.
4. There are strong arguments to be made that some procedures are low in value and high in cost. Value is a thorny topic, but this data forces us to ask hard questions about certain procedures.
5. Is fee-for-service the best system of compensating caregivers? It’s easy to see what pays. It’s surely not talking to patients about eating less, moving more and going to bed on time. Could we do better with incentives?
6. Perhaps the most provocative aspect of this story is whether there will be a collective shunning of context and default to intuitive thinking. Will we take the time to engage our slow-thinking analytical mindset? Will he heed the advice of those who urge us to consider the limits of this data? This NPR post, for instance, outlines the many voices of reason within mainstream media. Don’t rush too judgment is the take home.
Within hours of the breaking story, journalist Jason Millman, from the Washington Post, published responses from many of the top-earning doctors. Yes, there were reasonable explanations for some.
My initial impression of this story is that it is a momentum changer for US health care policy. It’s going to make us look inward, ask hard questions, and engage our thinking neurons.
My brain was buzzing all day. That’s a good thing, right?
JMM
This post first appeared on drjohn.org.
