ASCO urges CMS to resolve data dump issues, cites inaccuracies

The release of Medicare physician reimbursement data earlier this month resulted in displeased physicians and medical societies, many of whom said the data are inaccurate, incomplete and lack context.

Among those displeased is the American Society of Clinical Oncology, which on April 16 issued a letter to CMS urging it to provide an immediate solution to cited inaccuracies, which include misspellings and misleading information.

Richard L. Schilsky

“There are a lot of inaccuracies,” ASCO Chief Medical Officer Richard L. Schilsky, MD, FASCO, told HemOnc Today. “Our members are finding all kinds of problems. Many don’t even see themselves listed as oncologists. One of our most prominent members attempted to find himself in the database, and it turns out he’s listed as an endocrinologist.”

But the problems go beyond inaccuracies.

More than misspellings

According to Schilsky, oncologists have specific reasons their billing numbers may be higher than other specialties. He said patients with cancer are often older and more likely to have Medicare than private insurance, and many of the treatment methods are inherently more costly.

“What Medicare pays physicians has no relationship to the quality of care they deliver,” Schilsky said, adding that no context is provided in relation to the dollar figures. “Oncologists use some of the most expensive drugs on market. They have to purchase a lot of those in advance, so there is high overhead. Many of the drugs are dangerous, even toxic, to staff and the people who handle them, so they have to employ very skilled staff. There might be an oncology nurse and an oncology pharmacist just to administer these drugs safely to patients.”

“Other nuances” create bigger but inaccurate numbers for oncologists, Schilsky said. “The law requires that, in order to get reimbursed for chemotherapy administration, there has to be a physician onsite.” However, that one doctor monitoring a chemotherapy clinic may be billing for treatments prescribed by numerous physicians.

“All facility fees are billed under that physician’s name, even though that person may not be prescribing everything,” he said. In reality, many large practices bill under one or a limited number of doctors for an entire practice.

“The billing amount is not an accurate reflection of a doctor’s practice. It may be an accurate reflection of the practice overall, but it’s impossible to see that from the data,” Schilsky said.

Protecting patient relationships

Until these issues are resolved, ASCO has developed a resource center to help physicians navigate patient questions and concerns resulting from the data release.

“ASCO has developed talking points that our physicians can share with patients, who undoubtedly will have some questions about this,” Schilsky said. “We want people to understand that they shouldn’t make any assumptions if their doctor got a high number in Medicare reimbursement. The data are so out of context that it’s very difficult to interpret it with respect to the quality of care,” he said.

The data were released without any advance notice to physicians or opportunities to review or correct the numbers. According to Schilsky, “Lots of people were totally caught off guard and didn’t know how to explain it to patients because there was no opportunity for review.”

There is a concern that the data, provided without context or accuracy, will allow anyone biased against physicians to mine negative data that is incorrect.

“There is just a lot of opportunity here to continue to perpetuate inaccuracies and misrepresent the truth. We’re all for transparency, for quality improvement, and we do believe information should be readily available to patients about how doctors perform, how hospitals perform, but it is only good so long as what you are viewing is accurate information,” Schilsky said.

Physicians are also concerned about the potential to erode patient relationships. “If you’ve been seeing a doctor for your cancer for the last 5 years and then some data surfaces, it may threaten the bond of trust and may be completely erroneous. We don’t want people to be stressed out by something like that when they are being treated for cancer,” he said. – by Shirley Pulawski