Oncology Societies Warn of Distortion in Medicare Data Dump

Zosia Chustecka

April 11, 2014

Anger at the unprecedented release of Medicare data for individual doctors earlier this week is palpable in all the statements that have been issued in response by the leading oncology societies.

The American Society of Clinical Oncology (ASCO), the American Society of Hematology (ASH), the American Society of Radiation Oncology (ASTRO), and the Association of Community Cancer Centers (ACCC) have all condemned the release of figures without any context, saying this will lead to misinterpretations. In addition, they warned that some of the figures are just plain wrong.

ASCO said there were "extensive inaccuracies in the data for many oncologists throughout the United States," and also noted that physicians were not allowed to review their personal information for accuracy. Several have posted on Twitter that they found errors when they looked up their own name.

This is a "large and complex set of data about the number and type of healthcare services that individual physicians and certain other healthcare professionals delivered in 2012, and the amount Medicare paid them for those services," said ASH.

It is "intended to allow the public to identify outliers and patterns in payment," but in order to be useful to consumers in making value-based decisions, these incredibly complex data must be released with appropriate disclosures and explanatory statements, the hematology society added.

The Medicare claims data, released by the Centers for Medicare & Medicaid Services (CMS), 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," said the ASTRO.

"Cancer care is incredibly complex and often high cost. Releasing information that simply states that a particular physician billed Medicare for a certain amount of services does not tell the full story about the work being done to treat patients with cancer," said the ACCC.

"These numbers are only one piece of the puzzle and, taken alone, not a piece that is overly helpful to patients," it commented.

"Unlike many other specialties, cancer treatment involves very costly anticancer drugs. A large proportion of the money that is billed to Medicare is immediately returned to drug manufacturers and distributors to pay for high-cost cancer treatments, including chemotherapy, biologics, and other needed medications," the ACCC pointed out.

Less Transparency, Rather Than More

The way that the information was released, without any context, "makes healthcare delivery less transparent than it initially may seem," ASCO said.

One issue is that one physician's name may be used for all the billing that takes place at a clinic. This was the case for Minh Nguyen, MD, a hematologist-oncologist at Orange Coast Oncology in Newport Beach, California, who was highlighted in a Washington Post blog post that listed the top 10 billers. Dr. Nguyen received Medicare payments of $9.1 million in 2010, and was the 10th-highest biller of Medicare in 2012. But he told the newspaper that all the billings for chemotherapy drugs at his 5-physician practice were under his name.

However, the only other oncologist in the top 10 is being investigated for fraud. Dr. Farid Fata in Rochester Hills, Michigan, who received over $10 million in Medicare payments in 2012, has been charge with healthcare fraud in a federal case that opened in August 2013; the criminal case against Dr. Fata included numerous reports that he gave chemotherapy to patients who did not need it, and that he told patients that once they had chemotherapy, "they had to have it for the rest of their lives."

Appealing to the CMS to work with the oncology community to identify and correct data mistakes, the society also asks that the CMS refrain from releasing more information "until a more helpful process can be established that provides reimbursement information in the appropriate clinical context."

In the meantime, every large news organization is reporting the data. The Wall Street Journal has produced a searchable database and the New York Times has produced an interactive graphic.

Medicare Billing Is Not Revenue

A search of the numbers collated by the New York Times shows that specialists in hematology/oncology were the second biggest recipients of Medicare payments in 2010, at $2.09 billion dollars, split among 1831 Medicare billers.

They came second, behind ophthalmologists, who billed $3.3 billion (2995 specialists), and ahead of cardiologists, who billed $1.6 billion (2176 specialists).

In position 4, just below cardiologists, were specialists in radiation oncology, who billed $1.1 billion (968 providers). Further down (at position 8) were medical oncologists, who billed $621 million (522 providers), and down the list at position 20 were hematologists, who billed $83 million (71 providers).

However, ASCO points out that "most of the amounts shown in the Medicare database for oncologists are not, in fact, revenue to oncology practices."

"Instead, these Medicare payments merely cover the upfront costs of purchasing drugs for patients," the society said. "Cancer care is unique among specialties in the way it is reimbursed by Medicare. Oncology practices must purchase very expensive chemotherapy drugs for their patients prior to receiving reimbursement for those drugs from Medicare."

In addition, a substantial proportion of Medicare reimbursement also goes to providing the highly skilled professional staff necessary to care for seriously ill patients, such as oncology-certified nurses and pharmacists, ASCO said.

Similar points were made by ASTRO, which points out that radiation oncology is a specialty with unique costs — both nonphysician staff and equipment. Releasing Medicare claims data without context and details "opens the door for misleading interpretations," it said.

"As a specialty that effectively utilizes highly advanced, sophisticated technology that can cost millions of dollars, the claims data alone offer a distorted view of the revenue generated by radiation oncology practices," ASTRO said in a statement. " For instance, the reimbursement data do 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 society said.

"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 said.

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