Medicare Halts Release Of Much-Anticipated Data

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Above Photo: Janis Christie/ Getty Creative

The government had planned to share data with researchers on patients enrolled in Medicare Advantage health plans. Then, suddenly, it didn’t.

In the past few years, many seniors and disabled people have eschewed traditional Medicare coverage to enroll in privately run health plans paid for by Medicare, which often come with lower out-of-pocket costs and some enhanced benefits.

These so-called Medicare Advantage plans now enroll more than a third of the 58 million beneficiaries in the Medicare program, a share that grows by the month.

But little is known about the care delivered to these people, from how many services they get to which doctors treat them to whether taxpayer money is being well-spent or misused.

The government has collected data on patients’ diagnoses and the services they receive since 2012 and began using it last year to help calculate payments to private insurers, which run the Medicare Advantage plans. But it has never made that data public.

Officials at the Centers for Medicare and Medicaid Services have been validating the accuracy of the data and, in recent months, were preparing to release it to researchers. Medicare already shares data on the 38 million patients in the traditional Medicare program, which the government runs. (ProPublica has created a tool called Treatment Tracker that enables people to compare how doctors and others use services in the traditional Medicare program.)

The grand unveiling of the new data was scheduled to take place at the annual research meeting of AcademyHealth, a festival of health wonkery, which just concluded in New Orleans.

But at the last minute, the session was canceled.

The change caught researchers — and even some former Medicare officials — off guard as the data’s release was a highly anticipated expansion of the government’s effort to share information.

 

In a statement, CMS said there were enough questions about the data’s accuracy that it should not be released for research use. CMS said it will examine the data for 2015 “to determine if it is robust enough to support research use.”

Niall Brennan, until January the chief data officer of the Centers for Medicare and Medicaid Services, worked on the data — known as encounter data — during his time in office. “Hugely disappointing,” he tweeted, with a photo of the sign announcing the session’s cancellation. “Hope CMS not backsliding on #opendata.”

 

In response to a question about whether the data had problems, he tweeted, “Like any new data source [Medicare Advantage] data had some quirks to be sure but if it was used for payment why can’t it be used for research?” he said in a tweet this week.

Health economist Austin Frakt, who is affiliated with a number of academic institutions, said he was disappointed by the decision to halt the data’s release. He said he wants access to the data as a researcher — and as a taxpayer. “We are paying an enormous amount of money to private insurance companies … but we know very little about what we’re getting for that money,” he said.

Frakt notes that researchers know “vastly more” about traditional Medicare because the data has been available for decades. “The claim is that private insurers are innovating in ways that traditional program is not. We need to validate that. We need to know what they’re doing for the benefit of everyone. We can’t do that without the data.”

Frakt acknowledged that the data has limitations, “but I don’t think it justifies withholding the data. … Researchers are highly skilled at dealing with messy data. We’ve done it before.”

In recent years, private insurers that run Medicare Advantage plans have been under fire for allegedly overcharging Medicare. The Center for Public Integrity reported last yearthat more than three dozen audits had found that plans overstated the severity of enrollees’ medical conditions to garner more money. (The Center had to file a Freedom of Information lawsuit to access the audits.) In 2014, the Center’s reporting suggested that insurers had collected $70 billion in improper payments from 2008 to 2013.

Explore the details of Medicare’s 2014 payments to individual doctors and other health professionals serving more than 33 million seniors and disabled in its Part B program. See the project.

The Department of Justice recently intervened in two federal lawsuits in Los Angeles (here and here) accusing UnitedHealth Group of providing “untruthful and inaccurate information about the health status of beneficiaries” to boost its revenues. The company has denied wrongdoing.

If the data on Medicare Advantage plans was made available to researchers, it could shed light on these kinds of issues.

For its part, the insurance industry has been raising questions about the accuracy of the encounter data but said it did not ask CMS administrator Seema Verma to delay its release to researchers.

“The system used to capture encounter data has numerous unresolved operational and technical issues and fails to capture a reliable, comprehensive picture of beneficiaries’ diagnoses,” a spokeswoman for America’s Health Insurance Plans said in an email. “This could put payments at risk, which could also increase premiums and decrease benefits. We look forward to working with Administrator Verma and CMS to improve the encounter data and address these issues.”

Earlier this year, the Government Accountability Office issued a report calling on CMS to do more to validate the completeness and accuracy of the encounter data before using it as a basis for paying the health plans.

  • Aquifer

    It’s pretty damn obvious why the gov’t, refused to release the data – it would have confirmed that those plans were overcharging – so why would a gov’t want to fail to point that out – because those overcharges are gov’t subsidies to for-profit institutions – as the private insurers concerns about the “possibility” (read inevitability) of “increase(d) premiums and decrease(d) benefits” resulting from decreased revenue if those overcharges were eliminated …

    So can that data be obtained through a FOIA request?

    And which side did the DOJ “intervene” on in that suit?

  • DHFabian

    Low-income elderly and the disabled qualify for dual benefits, Medicare/Medicaid. Why would we be seeing an increase of seniors and the disabled enrolled in Medicare Plus? If so, it indicates an overall increase in incomes and assets among this group or Medicaid has lowered the income level at which one becomes eligible to Medicaid coverage.

  • kevinzeese

    Insurance company marketing — they are expert at selling people expensive policies that do not work.

  • Linda Jansen

    Wonder if there will be a whistle-blower in this case.

  • DHFabian: It’s because despite the Big Lie propaganda to the contrary, the Obamanoids, like the Bush League and the Clintonites before them, slashed the hell out of Medicaid, just as the Democratic (sic) Party in Washington state did.

    The Democrats also maliciously hide the fact some of the largest Medicare Advantage providers are non-profits such as Kaiser-Permanente (my provider) or co-ops. But the Obamanoid policies pay no heed to the profit/non-profit distinction and use their (very real and ultimately genocidal) war on Medicare Advantage to prop up another Big Lie — that the Democratic (sic) Party is battling the insurance barons and the prescription drug lords rather than enabling their obscene greed.

    That said, you obviously know nothing whatsoever of the Medicare/Medicaid realm, else you’d understand that Medicare itself is genocidally exclusive : the co-pays range from 20 to 50 percent and are thus forever beyond the reach of anyone who is not wealthy. While Medicaid helps people at the very socioeconomic bottom, that bottom is murderously low. I who since 2009 have had no income save Social Security — less than $1300 per month this year, (with no possibility of ever again having any supplemental income) — am adjudged by the politicians and welfare bureaucrats to be too well off for ANY Medicaid assistance. The combination of rent and medical expenses — and the millions of seniors and disabled people like me — Medicare Advantage is literally the only way I can go on living.

    Meanwhile we all know, or should know, the only way we’ll ever get anything better is by killing Capitalism, which — given how the Ruling Class has acquired all the powers of murder and destruction formerly attributed to the Divine Sadist worshiped by its god-opiated subjects — will never happen.

    Lastly, your slip is showing. Your nasty accusation of “an overall increase in incomes and assets” among people like myself is classic fascist hatemongering, which at the very least makes me wonder what federal agency you might be working for.

  • chetdude

    Personal anecdote. Thanks to the fact that even though it’s better than any other insurance that non-rich USAmericans can get, “standard” Medicare is the most punitive, most-expensive, least effective single-payer implementation on the Planet.

    After having to pay 20% of the bloated costs for a simple outpatient surgery in early 2011, I switched to a “zero cost” Advantage plan, one that took my medicare premium as full payment for a policy that paid all but 10% of the bloated “costs” of a heart attack, 2 day hospital stay and one stent (retail cost: $250K) I experienced in 2012…(saved me $2200 on my “co-pay”)

    Then I moved to a state where my ONLY viable “Choice” is a Kaiser Advantage Plan. At the end of last year Kaiser took advantage of a(n ACA?) loophole, cancelled my plan and “created” a plan with a new name (and the same coverages) and increased my premium by 60%…

    It would be very nice if we took a page from Taiwan’s book and created a Health Care system from the best of the best in the world but since that’s REALLY impossible, HR676 is the best we could hope for to replace insurance corporations and gain enough leverage to change the system from one driven by insurance, Big PhRMA and “Medical Center” corporation’s profits uber alles to a Health Care system.

  • One more point: while I cannot doubt the government’s motives for suppressing the promised data are malicious — if in fact we are part of the 99 Percent, we should assume everything done by the Capitalist-owned USian government (and all its state and local subsidiaries) is at least malicious and most often genocidal — in this instance the censorship may not be about greed per se. More rationally I suspect it’s because Medicare Advantage usage reveals what at total, pander-to-the-rich/murder-the-poor scam so-called “traditional” Medicare actually is.

    But when oh when will we wake the fuck up? No less than the First Nations folk before us, We the (surplus) People are now targeted by the Capitalists for genocidal extermination.

  • kevinzeese

    The interesting thing is that when Taiwan switched from a disastrous insurance based health system to a single payer system 20 years ago they looked at all the systems in the world and found US Medicare to be the best and they used it as the model for their system.

    In 1960s when Canada put in place its Medicare system — single payer — they also modeled it after Medicare.

    Unfortunately, over the bi-partisans in Washington, who want to privatize Medicare, have been undermining it, making it more expensive and covering less. When we call for Medicare for all we always call for improved Medicare for all because improvements are now needed, e.g. no co-pays or other financial barriers and coverage of all parts of the body including eyes, teeth and mental health. Improved Medicare for all will be a step forward for everyone, including seniors already on Medicare.

  • chetdude

    Very true, Kevin…

    And Medicare is still prey to the bipartisan consensus that continues to cause its rapid deterioration…

    Somewhat for the same reasons…