Medicare Payment Data Release Concerns Some Otolaryngologists

The most common scenario, he said, is a practice that treats a largely elderly patient pool, which would show those physicians receiving higher payments than their colleagues in practices with more non-Medicare patients.

Jonas Johnson, MD, the Dr. Eugene N. Myers Professor and Chair of Otolaryngology at the University of Pittsburgh School of Medicine, said, “This has been coming and will certainly offer the potential for misinterpretation of the data. Physicians at the high end may just work longer or see a larger proportion of CMS patients. So, until quality data is available, I expect the numbers will be hard to interpret.” Dr. Johnson, who is also past-president of the Triological Society, made the remarks on his own and not as a voice for the society.

Dr. Waguespack said he has heard “virtually nothing” from patients beyond the few days after the data was released in April amid intense media coverage. “I think as a specialty, we don’t appear to have a number of people who really appear to be outliers as far as what their Medicare receipts are,” he said.

But even though chatter about the data release has subsided, there still will be physicians who could be affected by the Medicare data, rightfully or not, Dr. Waguespack said. “There almost assuredly will be, even if it’s, for example, a practice that is limiting itself largely to geriatrics,” he said. “I think there will probably, as always, be a few individuals who have an appearance of, and in some cases potentially are, overutilizing services. But without knowing a lot more details about a practitioner’s patients and their disease burden, it’s very difficult to make any definitive statement.”

Robert Wah, MD, president of the AMA, said physicians have expressed concerns about the accuracy and limitations of the data. In some cases, he said, a physician who manages a group or practice may appear to be an outlier because a group of physicians bill under that physician’s identifier.

Also, he said, many physicians have told the AMA that because the CMS payment data includes reimbursement for expensive drugs, they have been unfairly portrayed as receiving significant revenue, even though the money was passed through to drug companies to pay for the cost of those drugs. The AMA has urged CMS to separate out those payments, Dr. Wah said.

How Useful Is the Data?

Otolaryngologists and other physicians whose patients ask about the payment data should emphasize that patients need to consider the quality of their care. “They should stress to their patients that the financial data released is misleading and does not capture what is really important: the quality of the care they are receiving that is helping them live healthier lives,” Dr. Wah said.