Thursday, April 10, 2014


By now most providers know that CMS has released numbers to the general public that were once privileged.  This is a major change in the policy of the past 4 decades.

For me this is equivalent to posting an annual IRS tax return for individual providers. Is this a civil rights violation, or a violation of privacy ? When I submitted my Medicare Enrollment Application I do not remember hearing or reading any small print stating that my medicare reimbursement figures would be made public.  Certainly the figures could have been masked with an identification code.

Is this a form of ‘crowdsourcing” ? Throw out the data and have readers compare notes to find previously hidden patterns to root out fraud and abuse?

When publishing this data CMS should have included several caveats when interpreting this information.  Although those in  health care know that these figures do not reflect operating expenses, or capital outlay.. Regional differences also play a role in big cities, rural areas, regional deficits in provider availabiltiy.  Some areas may have only one cardiologist and others may five cardiologists.  The figures did not distinguish age groups, a serious deficit in trying to interpret what the numbers mean. It also does not take into consideration areas of excellence whereby patients seek out experts in cancer, cardiology, neurosurgery, or referrals to such experts, at Universities.

Medicare equates this with the ongoing increased access to provider rankings and help in choosing a doctor.

Knowledgable experts and authorities have always had access to these important numberes for planning and reducing fraud and abuse.

NPR reported this story and adequately explained the caveats and pitfall with this change.

Reports indicate further reports will be announced, in regard to pharmaceutical use, payments to providers from pharma, durable medical equipment, entertainment lunches during lunch or evening CME activities.

Let’s equalize this process and disclose CMS reimbursements to the thousands of hospitals who receive CMS reimbursements.

It seems providers are the target for reform. If I were a paranoid person I might think this is designed to intimidate providers.  There are already effective means for CMS and insurers to analyze what doctors do and are paid.

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