We’re constantly bombarded with tales about the awesome power of computers to change our lives. 

In 2016, at the University of Tokyo, IBM’s resident artificial intelligence, Watson, accurately diagnosed a rare form of leukemia in a 60-year-old woman whose case had stumped the hospital’s human experts for months. After just 10 minutes of perusing 20 million articles, Watson clinched the diagnosis. Treatment was started and the woman’s cancer responded to it.

In a similar vein, the government has been quick to embrace the power of computers in clinical and surgical practice, and has decreed that physicians should get on board with electronic health records or start suffering monetary penalties. This mandate, originally called “meaningful use” but now known as “Advancing Care Information” within the Merit-based Incentive Payment system, is touted as improving health care in several dimensions, such as quality, safety, and efficiency, as well as improving care coordination and public health.

So, imagine ophthalmologists’ surprise three years ago when they learned about one particular aspect of the quality-based payment program at the time, as described by Chris Kent in this issue’s cover story on MIPS: 

“One problem that unfairly affected ophthalmologists in the past—especially retina specialists—is a thing called attribution,” Jeff Grant [of
HealthCare Management & Automation Systems] explains. “... Patients were ‘attributed’ to a particular doctor, based on factors such as how frequently the doctor was seeing the patient and whether the doctor was billing using evaluation and management codes. If you saw a patient often and used those codes—which retina specialists often do—then any Medicare charges associated with that patient were attributed to that doctor ... A retina patient might go to the hospital and have $20,000 worth of gastrointestinal surgery. Under this system, this cost was attributed to the retina specialist.”

To be fair, attribution is just one boneheaded aspect of a system that ophthalmologists seem to be succeeding in overall. Also, Mr. Grant explains
that, this year, efforts have been made to correct this glaring problem—though the results of the solution haven’t been seen yet—but that still means it took three years to get a high-tech system to display a modicum of common sense.

Since the government likes to dole out penalties to get results, maybe penalties can work the other way too: Under a new system, let’s call it the Watchdog Incorrect Payment System or WIPS, every time a physician gets the cost of a procedure wrongly attributed to him, the government will pay him 2 percent of what was billed. 

A few months of this, and I bet the government’s computer would get real smart, real fast.

—Walt Bethke, Editor in Chief

1. Feldman M. Watson proving better than doctors at diagnosing cancer. Available at https://www.top500.org/news/watson-proving-better-than-doctors-in-diagnosing-cancer/. Accessed 21 September 2018.
2. MIPS builds on meaningful use. Available at https://www.healthit.gov/topic/federal-incentive-programs/meaningful-use. Accessed 21 September 2018.