THIS WAS a breakthrough week for health-care transparency. For the first time, the Obama administration released doctor-specific information about Medicare payments, starting with 2012 data on $64 billion worth of billings. Journalists immediately set to work analyzing the data. Among some of the key findings: Just 2 percent of the 880,000 physicians accounted for nearly a quarter of the payments; reimbursements for prescription drugs accounted for an eighth of the spending; a handful of specialties, oncologists and ophthalmologists especially, accounted for a disproportionate share of the costs.
These and other data begin to illuminate the workings of a complex system of fee-for-service medicine whose seemingly uncontrollable costs have challenged U.S. policymakers for decades — yet disclosure had been resisted by doctors, who felt it would invade their financial privacy or distort public discussion by disseminating raw, out-of-context information. The latter concern was voiced last week, yet what was striking about the data release was how carefully news organizations explained its nuances to readers. Stories in major daily newspapers, including The Post, pointed out that much of the money paid to doctors for drugs went not to them but to pharmaceutical suppliers; the fact that 40-plus percent of the money covered overhead was also fully aired. Stories carefully distinguished between the several high-billing doctors who were suspected of or charged with fraud and those whose unusually large Medicare receipts reflected legitimate special situations.
In short, so far the disclosure, and the journalism, has worked just as hoped: to lay before the public not only costly fraud and abuse in Medicare, but also the legal workings of the system, some of which are debatable. A good example of the latter is the high billings of ophthalmologists, which appear related not only to an unsurprisingly high concentration of over-65 patients in a specialty related to vision disorders, but also to certain doctors’ use of a more-expensive brand-name drug that is not necessarily more effective than an alternative. Medicare’s policy of reimbursing physicians for the cost of the drug plus 6 percent may incentivize some of them to opt for higher-priced alternatives, as The Post’s Peter Whorisky, Dan Keating and Lena H. Sun reported.
It may be, as some physicians contend, that these higher costs are medically justified; now the public can consider that question far more intelligently than it could before the data release. Doctors, too, now know that their practices are subject to informed scrutiny by the taxpayers who ultimately support them. “This public release will create enormous social pressure to be cautious about being an outlier,” Peter J. Pronovost of Johns Hopkins Medicine told the Wall Street Journal. For the vast majority of doctors who play by the rules, and their patients, that pressure should present no problem. For those who game the system and the dishonest few who break the rules, we’d say it’s just what the doctor ordered.