Unprecedented Release of Medicare Data Raises Concerns About Lack of Context: Statements From COA and ASTRO


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The [Medicare reimbursement claims] data is incomplete, biased, without context, and an unrepresentative sample of Medicare reimbursement to oncologists.…

—COA
The amount that a physician bills and is reimbursed does not directly correlate to his or her personal income.

—ASTRO

In April, as part of the Obama administration’s work to make the U.S. health-care system more transparent, affordable, and accountable, the Centers for Medicare & Medicaid Services (CMS) released a vast amount of privacy-protected data on services and procedures provided to Medicare beneficiaries by physicians and other health-care professionals. The data, which is available at www.cms.gov, also shows payment and submitted charges for those services and procedures by provider.

In the May 1 issue of The ASCO Post, we published statements from the American Society of Clinical Oncology (ASCO) and the American Society of Hematology (ASH) on the release of the Medicare physician payment data. Both societies emphasized the need for greater context to appropriately interpret the data and cautioned that the numbers, as provided, could be misleading.

Statements by the Community Oncology Alliance (COA) and American Society for Radiation Oncology
(ASTRO), also issued at the time of the data release, sounded a similar note and are presented below.

Community Oncology Alliance Statement

The Community Oncology Alliance strongly disagrees with the release of physician-specific Medicare reimbursement claims data and the manner in which the Centers for Medicare & Medicaid Services released the data. The data is incomplete, biased, without context, and an unrepresentative sample of Medicare reimbursement to oncologists.… Further, CMS did not allow physicians an opportunity to confirm the accuracy of individual data and did not conduct any studies to assess how the data will potentially influence consumers, especially senior beneficiaries, about their medical care decision-making.

CMS has stated that “this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program.” That is impossible given that the data is simply an unscientific and inconsistent sample of reimbursement claims data—it provides no metrics on quality and value. COA believes that the data may well confuse seniors and others with cancer, adding unnecessary angst to an already emotional situation. As physicians we are first taught to do no harm to our patients. The release of Medicare physician reimbursement claims data may possibly result in inaccurate, misunderstood, and even harmful conclusions by cancer patients. 

COA strongly supports identifying physicians who may be fraudulently billing Medicare, which should be a top priority of CMS independent of releasing Medicare reimbursement claims data to the general public. COA also equally supports more transparency and accountability in medical care, especially in measuring the quality and value of cancer care. This is evidenced by COA’s Oncology Medical Home initiative and associated payment reform model based on quality and value metrics. Community oncology practices across the country are providing cost-effective cancer care that substantially reduces spending by Medicare and seniors, as documented by numerous national studies. CMS should be empowering cost-effective cancer care in the community setting and providing consumer-friendly quality and value data that will truly help in more informed decision-making. The release of Medicare reimbursement claims data is not a step in that direction.

American Society for Radiation Oncology Statement

The American Society for Radiation Oncology (ASTRO) is committed to transparency of Medicare information; however, ASTRO is troubled that individual physician payment data from Medicare released [recently] did not have the necessary context and details to provide an accurate picture of radiation oncology care….

The Medicare claims data released is limited and creates significant challenges to interpreting its meaning because it is not integrated with clinical data about how the care is provided and billed. As a specialty that effectively utilizes highly advanced, sophisticated technology that can cost millions of dollars, the claims data alone offers a distorted view of the revenue generated by radiation oncology practices. For instance, the reimbursement data does not reflect the substantial expenses associated with operating a radiation oncology center, including the costs of expensive equipment and maintaining a well-trained and specialized team, including radiation oncology doctors, medical physicists, dosimetrists, radiation therapy technicians, nurses and other health professionals such as dieticians and social workers….

As context, radiation oncology accounts for only about 2% to 3% of the almost $87 billion paid (approximately $2.4 billion) by Medicare via the Medicare Physician Fee Schedule, based on the 2012 claims data. The contributions radiation oncology has made to improving cancer cure rates indicates that Medicare is getting strong value for the relatively little it spends. The amount that a physician bills and is reimbursed does not directly correlate to his or her personal income. Preliminary analysis of the data estimates that approximately 82% of radiation oncology billing dollars pay for the physical and practical overhead expenses, and approximately 18% represents the physician’s work….

ASTRO shares CMS’s commitment to transparency, particularly as the health-care payment system shifts away from the fee-for-service model to one based on value. ASTRO is proud to continue to participate in a thorough dialogue with CMS as new payment models are developed and patients can become better-informed health-care consumers. ■



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