Data

Carter L. Alleman, J.D.

Growing up, going to the doctor’s office was never on my top ten list of things to do. I never liked getting shots, or sitting in the examination room - which smelled funny, or listening to the doctor talk to my parents in the cramped office; However, looking back on those memories now make me nostalgic for that personal, face-to-face care.

Recently, I was sitting in an emergency department at a local hospital watching the staff move about, all of whom seemed to be tethered to a computer and constantly typing. In the middle was a cubical farm which could have been transported from any of the surrounding offices with nurses and doctors working on computers like office workers. All typing for the data.

Data is driving Capitol Hill and Centers for Medicare & Medicaid Services (CMS) decision makers to create what they believe is the best system under Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA). Health groups are finding that Congress is not interested in any delays in the implementation of MACRA regardless of the fact that its April 2016 and the proposed rules for the Merit-based Incentive Payment System (MIPS) which starts to take in data in 2017 have not even been published for comment yet. But to Congress, all MACRA is doing is just recapturing the data that is already out there in another payment model, regardless of the fact that the data may not be complete.

The model that is keeping me up at night is not MIPS but the alternative payment model (APM). The discussions that are being held around healthcare associations are mixed with fear, apprehension, and confusion. No one knows exactly what this model will ultimately look like, however Congress intended that the APM would be the silver bullet to the question of how to pay specialists for their care. I took stats in college and I find myself going back to those old class notes (in paper form) to brush up on the statistical modeling that is going to be necessary to make sure an APM has the necessary risk load within its patient population. I cannot understand how this will make surgeons’ lives easier or more fulfilling because Congress is expecting the surgeon to not only to a surgeon, but also a statistician, an actuarial, and a business manager just to get paid from the sliver of Medicare payments available.

Consumers are using data in ways that were never thought of in the past. You can go online and find the reviews of movies, restaurants, clothing, shoes, socks, anything you can think and also your doctor. With CMS release of its data sets, many third party sites are now creating their own types of reviews of surgeons and their care. Even when these groups are asked to explain that the data from CMS is incomplete, the groups reply, “oh well, it’s the best we have.” Did Congress intend for this to happen let alone CMS, probably not, but it is happening and it needs to be fixed. Should CMS do a better job of capturing this data and explaining the inconsistencies, of course, but Congress should hold hearings to examine why this data needs to be collected in the first place. I am sure at these hearings or in a report, Congress would find that with each click of the keyboard, a patient becomes a data point and nothing more.

Advocacy is key with data. Congress is in session about for about fifty more days before the election season truly begins for them. That means the Members are back in their districts more than ever. Find your Member and try to discuss with them the actual worth of data and how it impacts your practice. Let them know that their ideas are going to change healthcare in ways they never intended and we should all slow down with implementation until everything is laid out. Tell them that because programs are hastily rolled out that you are at the mercy of incomplete data sets judging your practice and your livelihood. The Members will listen because they have to because to them every vote counts. And that is the data points they are most concerned about.