Medicare Payment Data Release Concerns Some Otolaryngologists

In April, when the Centers for Medicare and Medicaid Services (CMS) released a massive amount of data pertaining to how much physicians are paid through Medicare, otolaryngologists at Albany ENT & Allergy Services in New York discussed the process and its implications, including the attention focused on an ophthalmologist in Florida who had been paid $21 million in 2012. The practice also reviewed its own Medicare payment data, and neither the group nor any of its seven physicians was an outlier.

But since then, there has been little discussion of the data release, said Gavin Setzen, MD, president of the Albany practice and president of the New York State Society of Otolaryngology. “I think, to an extent, the focus and attention has subsided,” he said. Neither his otolaryngology colleagues nor patients of his practice have brought up the topic of Medicare payments very much since then, he said.

But even though transparency is, as they say, “a good thing,” otolaryngologists still wonder about the potential effects of the release of that enormous database and are hoping CMS refines the information to make it more useful. The American Medical Association (AMA) is pushing for CMS to give physicians a way to respond to—and potentially correct—information in the data set.

The April data release included numbers on Medicare payments to 880,000 physicians, broken down by payment type. The release came after court battles and resistance from the AMA and others. In 2013, the courts vacated an injunction in place since 1979 that blocked release of Medicare payment information to individual physicians. In response, CMS created a new policy on Freedom of Information Act requests, and the release of the Medicare payment information is a result of that new policy.

CMS spokesperson Rachel Maisler, in response to e-mailed questions, issued a statement she said was “generally attributable” to CMS. “This data is useful for consumers and other stakeholders because it sheds light on the Medicare fee-for-service portion of a physician or other healthcare professional’s practice,” her statement read. “The data includes information on the types of services paid under Medicare as well as the average Medicare payment for those services.”

Asked whether the release of the data has helped pinpoint suspected cases of fraud, Maisler didn’t respond directly but said the U.S. government “recovered a record $4.3 billion in taxpayer funds last year on behalf of our federal health programs,” helped by new tools created by the Affordable Care Act.

Potential for Misinterpretation

Richard Waguespack, MD, president of the American Academy of Otolaryngology-Head and Neck Surgery, said that without context, it is very easy to misinterpret the data. About a year ago, he moved from private practice to a university, a change that appeared to skew his Medicare numbers. “It looked to me like the numbers being reported on me were low,” he said. “Because I was not able to submit charges during a transition period to the university, there might be an appearance that I got less money. I could see a situation where the converse might be true, when those charges that were ‘on hold’ got released. It would just be difficult for the public to judge what’s actually going on.”