360° Coverage : Medicare's Big Data Dump Is Just That - A Dump

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Medicare's Big Data Dump Is Just That - A Dump
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Medicare's Big Data Dump Is Just That - A Dump

Apr 15 2014, 6:35am CDT | by

Based on the headlines, many might think that the sole purpose of the Medicare data (released last week) was a scavenger hunt for the “Medicare Millionaires.” There was certainly no shortage of...

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15 weeks ago

Medicare's Big Data Dump Is Just That - A Dump

Apr 15 2014, 6:35am CDT | by

Based on the headlines, many might think that the sole purpose of the Medicare data (released last week) was a scavenger hunt for the “Medicare Millionaires.” There was certainly no shortage of headlines with that exact phrase.

For those so inclined, the Medicare PUF (Public Use Files) are available in two formats (here), but fair warning – the uncompressed tab delimited file containing more than 9 million records is about 1.7GB. The Excel format is divided alphabetically into 12 separate files, so that could be a little easier to work with.

The trouble, of course, is that data (any size) isn’t insight and in this case specifically, revenue isn’t profit. Large and frequent Medicare bills are often legitimate and often get processed for many providers through a single name or entity.

Also, while the data is accurate – it’s incomplete. It doesn’t include payments through private insurers, Medicaid or other passive sources of income (ie: surgical or diagnostic imaging centers), and it doesn’t include the most important element of all for true insight – quality. Using a consumer brand analogy, procedure pricing alone is like two 4-door sedans priced $20,000 apart – with no other information. Brilliant.

What it definitely does do is provide the same shock and awe we’ve seen before with Steven Brill (Bitter Pill) and Elisabeth Rosenthal’s entire series on pricing (starting here) at the New York Times. I went as far as to call pricing transparency the healthcare “Story Of The Year For 2013″ (here).

It definitely manages to capture the imagination around a hopeful (and potentially large) impact on pricing. So let’s see the shock and awe.

  • 880,000 providers were paid about $77 billion by Medicare in 2012
  • Total charges for 2012: $252 billion. Total paid-out: $77 billion (roughly 31%)
  • Highest 2% of physicians represented 24% of total Medicare payment (over $18 billion)
  • Largest specialty by payment – Ophthalmology (17,000)
  • Almost 4,000 medical providers were paid $1 million or more (the “Medicare Millionaires”)
  • About 7 medical providers were paid $10 million or more
  • 1 Opthamologist in Florida (already under FBI investigation) was paid over $20 million (for about 900 patients)
  • 1 Cardiologist in Florida was also paid over $20 million
  • 1 Oncologist in Michigan was paid over $10 million (indicted for fraud)
  • 1 Anesthesiologist in Rhode Island was paid over $3 million (also indicted for fraud)
  • 100 Doctors received a total of $610 million
  • A common eye disorder in the elderly was the largest single reimbursement procedure – about $1 billion for 143,000 patients
  • There’s a significant gender imbalance among the highest paid – of the Top 10,000 billers – less than 11% were women

The list goes on. But what’s the value of this to any of us as patients – or to the much larger national need for healthcare reform? Not much.

The hope, of course, is that pricing transparency alone will unleash market forces which will fuel heated competition which will force lower prices. But hope isn’t a strategy when the system is running at over $3 trillion a year – and growing at about 5% per year for as far as the eye can see.

The most impressive patient service I’ve seen so far is the Wall Street Journal’s online search tool which returns the number of procedures performed (and billed to Medicare – paywalled here). That has some potential value for patients who can now compare the number of procedures performed (and billed to Medicare) in the broader assessment of a provider’s skill. Unfortunately, without information around outcome, it too is very shallow on real insight.

null  If transparency can accelerate the debate (and reform) around actual pricing – it does have broader value. In the meantime, 9 or even 90 million records alone isn’t very insightful.

Transparency will help – in fact it’s a prerequisite – but transparency is not going to be enough.” Steven Brill – Keynote Presentation – The National Summit on Health Care Price, Cost and Quality Transparency

 
Update
10

7 weeks ago

RM47mil KWSG contributions still unclaimed

Jun 9 2014 7:54am CDT | Source: Business Times Malaysia

KUALA LUMPUR: About RM47 million of contributions in the Teachers Provident Fund (KWSG) still remain unclaimed, the Dewan Rakyat was ...
Source: Business Times Malaysia   Full article at: Business Times Malaysia
 

 
Update
9

7 weeks ago

Gold shop lost almost RM1mil

Jun 9 2014 3:50am CDT | Source: Business Times Malaysia

KANGAR: A gold shop owner lost almost RM1 million after after the safe on in his shop was broken into by ...
Source: Business Times Malaysia   Full article at: Business Times Malaysia
 

 
Update
8

7 weeks ago

Motion to debate MAS losses in Dewan Rakyat rejected

Jun 9 2014 3:39am CDT | Source: Business Times Malaysia

KUALA LUMPUR: AN emergency motion to debate the losses incurred by Malaysia Airlines last year, amounting to RM1.2 billion was rejected by the ...
Source: Business Times Malaysia   Full article at: Business Times Malaysia
 

 
Update
7

7 weeks ago

MH370 Tragedy: Hisham: RM27.6 mil spent on 1st phase of SAR

Jun 9 2014 2:11am CDT | Source: Business Times Malaysia

KUALA LUMPUR: Malaysia spent some RM27.6 million in its first phase of the search operations for missing Malaysia Airline flight MH370, said Acting Transport Minister, Datuk Seri Hisha ...
Source: Business Times Malaysia   Full article at: Business Times Malaysia
 

 
Update
6

7 weeks ago

9.1m litres of diesel seized in a month

Jun 8 2014 1:11am CDT | Source: Business Times Malaysia

PUTRAJAYA: The Domestic Trade, Cooperatives, and Consumerism ministry has seized some 9.1 million litres of diesel and property worth RM58 million since mounting ‘Operasi Diesel Selatan’ in ...
Source: Business Times Malaysia   Full article at: Business Times Malaysia
 

 
Update
5

8 weeks ago

Girl, 9, awarded RM2.78m compensation for medical negligence

Jun 6 2014 4:56am CDT | Source: Business Times Malaysia

KUALA LUMPUR: A nine-year-old girl who suffered brain damage during her birth at a government hospital was awarded over RM2.78 million i ...
Source: Business Times Malaysia   Full article at: Business Times Malaysia
 

 
Update
4

8 weeks ago

Malaysia's total trade in April up 12pc

Jun 5 2014 11:52pm CDT | Source: Business Times Malaysia

KUALA LUMPUR: Malaysia's total trade in April 2014 rose by 12 per cent from a year ago to RM123.86 billion due to growing trading activities, International Trade and Industr ...
Source: Business Times Malaysia   Full article at: Business Times Malaysia
 

 
Update
3

8 weeks ago

Works Ministry to spend RM20m for upgrading works at 50 accident black spots

Jun 4 2014 11:35pm CDT | Source: Business Times Malaysia

JOHOR BARU: The Works Ministry will implement upgrading works at 50 accident prone locations in the country that have been identified this year invol ...
Source: Business Times Malaysia   Full article at: Business Times Malaysia
 

 
Update
2

8 weeks ago

Najib launches loan scheme for Ramadan traders

Jun 4 2014 10:24pm CDT | Source: Business Times Malaysia

PUTRAJAYA: Prime Minister Datuk Seri Najib Razak today launches RM45 million Ramadan Bazaar ...
Source: Business Times Malaysia   Full article at: Business Times Malaysia
 

 
Update
1

8 weeks ago

Residents bring up objection against Kidex to Suhakam

Jun 4 2014 4:49am CDT | Source: Business Times Malaysia

PETALING JAYA: A group of 20 Petaling Jaya residents held a meeting with the Human Rights Commission of Malaysia (Suhakam) over their objection against the proposed RM2.2 billion Kinrara Damansara Skyway (Kidex ...
Source: Business Times Malaysia   Full article at: Business Times Malaysia
 

 

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