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On the Third Hand: Physician pay

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On the one hand, I’ve been a data junkie for so long that I can remember being thrilled when I could do the database searchers on CD-ROMs, rather than going through libraries’ bound volumes of musty old magazines for the data.

So, I truly love the new 2012 Medicare physician pay database. I tried plunking the name of about every doctor I’ve ever personally met into The New York Times’ version of the database.

Ordinary people who stare at me blankly when I try to explain what I do for a living came up to me and lectured me on how we all should rise up and revolt against all of those greedy eye doctors.

I know from first hand experience that, whatever tendency toward stonewalling that health insurance companies may possibly have, doctors have a strong tendency of their own to game the system.

But, on the other hand, I think looking at provider pay data is an example of where you have to be a kraken to have enough hands to deal with all of the arguments for and against the proposition that certain providers, or groups of providers, were underpaid, or overpaid, or paid in some other way that helped or hurt the cost or quality of health care.

Some high-billing doctors may simply include more equipment and drug costs in their bills than others because that’s how their specialties work.

Some apparently low-billing doctors may have figured out to milk Medicare like a cow by splitting a huge volume of fraudulent claims into many innocent-looking, hard-to-group transmissions.

The smartest Medicare con artists will never appear near the top of any Excel spreadsheet column that’s sorted by dollar volume because they have thought long and hard about how to look tediously average.

On the third hand, even if we look at Medicare pay only for honest physicians who followed the billing rules the same way, had comparable types of practices, and, in general, were great humanitarians, simply looking at pay ignores considerations that are extremely important to patients and payers.

Just about everyone wants Medicare enrollees to live long, comfortable lives, with as few limits on activities of daily living (ADLs) as possible.

A bare ranking of Medicare spending unaccompanied by any data on mortality and changes in ADL limits is more of a curiosity than a useful tool.

If, for example, it turned out that some of the now-famous high-billing eye doctors had helped a high percentage of older patients keep their eyesight, that effort to prevent disability and keep the patients from needing formal long-term care (services) would, obviously, have a high value.

On the fourth hand, Medicare has really tough, possibly unrealistic rules. Maybe, in some cases, doctors and hospitals are committing what Medicare views as felonies to come up with the resources to care for indigent patients, or, in the case of hospitals, to preserve facilities that seem unnecessary today but could be useful if a giant flu pandemic pops up, or if Ebola finds a way to cross the Atlantic Ocean.

We need, as a society, to figure out how to admit to ourselves that we have tangled the health care system in so much bureaucracy that, just as people in North Korea may feel as if they have to become black marketeers simply to survive in that system, the players in our health care system may sincerely feel as if they have to commit offenses against our own rules to survive in our system.

So, those numbers must say something, but it would be a lot easier to understand what if we weren’t all so tangled up.

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