CMS Makes Medicare Physician Payment Data Available Online

April 9, 2014 in News

On Wednesday, CMS posted online Medicare physician payment data, marking the first time such data has been released to the public since 1979, the Los Angeles Times reports (Terhune et al., Los Angeles Times, 4/8).

Background

A federal judge in May 2013 lifted a 33-year-old injunction that barred the government from giving the public access to a confidential database of Medicare insurance claims.

The court injunction stemmed from a lawsuit that the American Medical Association and the Florida Medical Association filed to prevent former President Jimmy Carter’s administration from publishing a list of annual Medicare reimbursements.

The database, known as the Carrier Standard Analytic File, contains information on physicians and other health care providers participating in Medicare who are paid on a fee-for-service basis. It incorporates all physician claims that Medicare paid directly.

About the Data

The newly released data include information on payments made under Medicare Part B in 2012 to all providers who participated.

Specifically, the data will include:

  • Physicians’ names and addresses;
  • Summaries of the services provided; and
  • The amount providers were paid for the services.

The data do not include any patient information. Further, CMS will not release any information on providers with fewer than 11 patients who are Medicare beneficiaries (iHealthBeat, 4/3).  

Data Details

Overall, the data show that Medicare paid out $77 billion to more than 880,000 health care providers in 2012, including $12 billion for about 214 million office and outpatient visits (Abelson/Cohen, New York Times, 4/9).

According to the data:

  • 2% of physicians and other individual providers accounted for almost one-quarter of the $77 billion total;
  • About one-quarter of providers participating in Medicare receive about three-quarters of the total payments; and
  • Specialists tended to receive higher reimbursements (Los Angeles Times, 4/8).

Reaction

Marty Makary, a cancer surgeon at Johns Hopkins School of Medicine and the author of a book that argues for making data on doctors and hospitals more publicly available, said, “While the data are not perfect, this is a major milestone in health care transparency” (Begley/Pell, Reuters, 4/9).

Paul Ginsburg, a health economist and professor at the University of Southern California, noted that insurers using both the Medicare data and their own information will “have a lot more to work with” in determining how physicians treat their patients, such as whether they order too many tests or if they are slow to operate (New York Times, 4/9).

John Santa, a doctor and medical director for Consumer Reports, also noted that the data could raise some red flags, saying, “If you see that a doctor is doing a procedure hundreds or thousands of times that should be done only on a small number of patients, you wonder” (Reuters, 4/9).

However, some stakeholders cautioned the public against misinterpreting the data, the Los Angeles Times reports.

For example, federal officials said that the high payouts do not necessarily indicate instances of fraud or over-billing, as payments could have been boosted by physicians treating particularly ill populations or because they have tailored their practices to treat Medicare beneficiaries (Los Angeles Times, 4/8).

In addition, other experts said that an individual doctor might seem to have been paid for an unusually high number of services because he or she oversees medical residents or physician assistants, while billing for the services him or herself.

Ardis Dee Hoven, president of the American Medical Association, said, “We know there are going to be limitations” because it is “raw claims data.” Hoven added, “This gives us no window into quality or anything of that nature,” such as whether patients benefitted from treatments or if the surgeries and medical services were necessary. In addition, Hoven said that physicians should have been able to review the data, and that the information could contain flaws (Reuters, 4/9).

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