WASHINGTON — Cancer doctors received about $275 million from the federal government and the elderly last year as part of a yearlong research project that many doctors believe won’t produce any useful findings.
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Under the program, the federal government paid $130 each time a chemotherapy provider assessed a Medicare patient’s pain, fatigue and nausea. The payments were designed to encourage doctors to report information that might one day lead to improved care for cancer patients.
In a report to be released Wednesday, the inspector general for the Health and Human Services Department cast doubt on whether the money was well spent. He questioned the integrity of the data that doctors submitted.
“We identified numerous anomalies and gaps in the data and collection methods,” said the report from Inspector General Daniel Levinson.
Levinson concluded the report by calling the data “unreliable.”
While the federal government will foot the bill for most of the unreliable data, senior citizens and disabled Americans on Medicare paid, too. That’s because they were charged $26 each time their doctors billed Medicare for submitting information about their side effects.
Doctors, meanwhile, made tens or hundreds of thousands of dollars off the program.
The chairman of the Senate Finance Committee, Sen. Charles Grassley, R-Iowa, said taxpayers and beneficiaries were “bilked” because they paid for services that physicians are already supposed to provide.
Medicare officials disputed that the program was wasteful. They said the program was an initial step in the Bush administration’s push to measure the quality of health care.
The project proved valuable in showing that it was indeed feasible to get doctors on a large-scale basis to report important quality measurements from their offices, Medicare officials said. In coming years, those measurements will be refined and improved, which could lead to potential breakthroughs in care.
“We’re trying to go from a system that is completely blind to what goes on in the doctor’s office to one that is highly informed and very helpful to the practicing doctor and to the beneficiary through transparency and quality measures,” said Dr. Peter B. Bach, a senior adviser at the Centers for Medicare and Medicaid Services.
The government already gives hospitals more money to submit certain quality measurements. For example, CMS measures how often hospitals give heart attack patients aspirin upon arrival. Medical experts recommend such a measure because aspirin can prevent clotting, which can help prevent a second heart attack.
Now, the government is expanding that effort to doctor’s offices. Bach said CMS has altered the program reviewed by the inspector general to get more detailed reporting from oncologists at about a fifth of the price tag from the year before.
“If you look at it in a vacuum and imagined we would never do anything going forward, I would probably agree with you. It’s like, ’Gee whiz, that’s a lot of money to spend for data that’s not entirely valid. Why did you do this? These are my tax dollars.’ But I don’t think that’s a fair way to evaluate it,” Bach said. “I think we’ve shown this had a direction.”
About 90 percent of eligible health care providers participated in the program. The median amount paid to each physician was $23,000. But some doctors got a lot more.
Florida physician billed U.S. $625,803
The top 10 billers, whom the IG declined to identify, received more than $270,000 each. One oncologist in Florida billed the government for $625,803. Another in Kansas billed for $507,563.
The Centers for Medicare and Medicaid Services regularly carries out research, but the chemotherapy project is by far the biggest. It was estimated to cost $300 million, including the beneficiaries’ copays. The next largest project will cost $60 million over eight years.
A commission that advises Congress on Medicare issues noted in January that it visited oncologists in five states as part of a review of the program.
“Most oncologists did not believe it would lead to quality improvements for patients or produce any useful research findings,” the inspector general’s report said in quoting the Medicare Payment Advisory Commission.
The commission also said projects should be used to test innovations in health care rather than “as a mechanism to increase payments” to doctors.
“It looks like the Medicare program has played games and used demonstration projects, whose legitimate purpose is to test new and innovative ideas for delivering health care, for questionable purposes,” Grassley added.
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