Akhilesh Pathipati

Viewpoints: The right approach to releasing Medicare data

Published: Friday, Apr. 11, 2014 - 12:00 am

The Obama administration recently announced the release of Medicare billing data for individual physicians. The public can now view physician names, addresses, the services they provided, what they charged for those services, and how much they were paid by Medicare.

The release has been hailed as a move toward greater transparency in health care. Supporters argue that the availability of data will help eliminate fraud in Medicare billing and will help consumers make more informed decisions about which doctors they should see. For example, patients would be able to look up whether their surgeon has experience performing a certain procedure and could also evaluate whether the surgeon has faced a high rate of complications.

There is no question that eliminating fraud and giving patients better information are admirable goals. The problem is that this data release is unlikely to accomplish either one.

Medicare fraud is certainly an important issue. The Office of Management and Budget estimates that Medicare made close to $50 billion of “improper payments” in 2010. However, making data publicly available will not change that. Billing data is already compiled and subject to audits – the government holds the responsibility for the integrity of its program. Individual consumers are unlikely to review physician claims and take action against them.

The more relevant concern then is whether patients will be able to use the newly released data to become smarter consumers of health care. Yet providing information without the tools to understand it is an approach filled with potential pitfalls, specifically surrounding data access, comprehension and accuracy.

First, releasing information to the public does not guarantee that people will look at it, or even know where to find it. A 2012 report from the Agency for Healthcare Research and Quality (a part of the U.S. Department of Health and Human Services) found that public reporting on physician quality metrics did not change consumer behavior for individual patients, consumer groups and payers. The primary reason given was that people did not know that such data existed.

The second challenge is comprehension. Even if consumers access the database, it is possible that they will not understand it. The AHRQ report also notes that patients did not respond to prior attempts at public reporting on physicians because “information was not presented in a comprehensible way.” After all, it is difficult to know where to look when presented with a large spreadsheet of data.

A related, potentially more troubling concern is that patients will misinterpret the data. Health care is a complex field with many hidden variables. Data surrounding complication rates provides a simple but useful example of this principle.

If Physician A has a higher rate of complications than Physician B, a patient might conclude that Physician B is a superior doctor. However, the discrepancy may simply be because Physician A sees more patients from high-risk groups, such as low-income populations. Poorer patients tend to have more complications because they have difficulty buying necessary medications, eat less healthy foods, and a host of other factors that are not under the doctor’s control.

A cursory review of the data would not have captured such nuances. It is possible to account for such confounding variables in evaluating physicians, but only if the evaluator understands how to interpret the information. Otherwise, patients may respond by avoiding physicians who care for sicker populations, thereby creating an incentive for physicians to avoid treating those patients in the future.

Finally, some consumers may access and comprehend the data, but the data itself may contain inaccuracies. Individual Medicare claims data was last released to the public in the 1970s, but had a number of errors, including flaws in accounting and misattribution of reimbursements. Such clerical mistakes could prove to be extremely harmful to a physician’s reputation. The American Medical Association has therefore pushed to allow physicians to validate their information before its release.

The public release of Medicare billing data is a well-intentioned policy. It is in society’s best interest to have knowledgeable patients and accountable doctors. For it to work, though, the information must be accompanied by support tools. The government or other organizations must find a way to distribute the information. Once it’s distributed, consumers must learn how to make it meaningful.

The challenges surrounding the release of Medicare billing data are not insurmountable. But without the right approach, it may do more harm than good.


Akhilesh Pathipati is a Stanford medical student and Harvard graduate who has worked on health initiatives in Massachusetts and California. He is a Sacramento native.

Read more articles by Akhilesh Pathipati



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