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CMS releases new Medicare Part B reimbursement data
The annual update on physicians’ Medicare Part B reimbursement was released this week by CMS, and the data showed that nearly $90 billion in Medicare payments was paid out to over 950,000 health care providers across all 50 states, Washington, D.C. and Puerto Rico.
“These data releases will give patients, researchers, and providers continued access to information to transform the health care delivery system. It’s important for consumers, their providers, researchers and other stakeholders to understand the delivery of care and spending under the Medicare program,” Andy Slavitt, CMS administrator, said in a press release.
The recently released data includes information on the services and procedures provided to Medicare beneficiaries, as well as the bills for those services and procedures, by physicians and other health care providers. The data set allows users to compare by physician, specialties, locations, types of medical services and procedures delivered, Medicare payments and submitted charges by entering the physician’s National Provider Identifier or the Healthcare Common Procedure Coding Systems’ (HCPCS) codes for services physicians provided.
Updated features of the data include flagging for whether an HCPCS product/service is a drug as defined by the Medicare Part B Drug Average Sale Price, consumer-friendly descriptions, more comprehensive summary files and new enrollment files for state-level and hospital referral region-levels. The 2012 data set was updated and republished to include the new features as well.
While CMS said that the new data will allow for the examination of trends across physicians and specialties, as well as geographic locations, there are limitations to the dataset that are noteworthy. Data parameters include information not representing all patients within a practice, since physicians treat many patients not covered by Medicare Part-B. Lack of consideration for practice location and quality of care are also considered limitations to the data.
Medicare payments based on care quality, rather than quantity, is a goal the CMS is working toward to achieve “better care, smarter spending and healthier people throughout the health care system,” according to a press release. CMS believes that the sharing of Medicare data will help achieve that goal.
“Data transparency facilitates a vibrant health data ecosystem, promotes innovation, and leads to better informed and more engaged health care consumers. CMS will continue to release the hospital and physician data on an annual basis so we can enable smarter decision making about care that is delivered in the health care system,” Niall Brennan, CMS chief data officer and director of the Office of Enterprise and Data Analytics, said in the release. – by Casey Hower
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Health insurers, private and public, ostensibly strive to ensure that the care they pay for actually provides benefits to their subscribers/participants at reasonable cost. As a provider and a patient, I like the idea of quality health care. However, releasing data on providers’ charges and payments doesn’t seem to offer any real benefits to anyone. I don’t think this study sheds any light on the relative skills of one provider compared to another, as with measuring outcomes. Even worse, I doubt that a very high number or percentage of patients will access the information, anyway, resulting in significant expense to the government without any real benefit to anyone.
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The annual physician claims data release by Medicare, which represents only 12% of Medicare spending on health care services, is usually accompanied by significant physician trepidation.
There are definite problems with the data such as not accounting for the cost of delivering care, which may give the public the wrong impression about how much physicians are actually earning. However, on balance, transparency is helpful to assist physicians and researchers to assess trends in care delivery. It may even help identify outliers who may be able to assess their own practice patterns to make sure that they are providing appropriate and cost-effective care resulting in cost savings to the system.
Separating out drugs from the physician payments is a big step forward to make it clear as to where taxpayer dollars are directed in the Medicare part B program and to more correctly reflect what physicians are actually paid for their services. Last year physicians providing expensive eye medications were unfairly tagged as being huge outliers until it became clear that the vast majority of those funds were actually a pass through to the drug company selling the drug in question.
It is important to realize that claims data has very little relation to effectiveness, quality, efficiency or good outcomes. CMS needs to focus on developing quality of care and outcomes metrics in partnership with physicians. Getting that kind of data can truly move the needle on providing quality care.
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This year’s data dump of aggregate payments made by CMS to individual physicians is a bit anti-climactic. While this level of transparency might have made some uncomfortable in the past, the massing of raw data for individuals working in myriad different practice settings, providing many different kinds of services, including pharmaceuticals, without details of quality, value and outcomes makes it difficult to know what these numbers mean. I don’t think consumers and their doctors will find this data of much value, although it may be useful from a health policy and planning standpoint.
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The American Academy of Dermatology Association supports transparency that provides meaningful and reliable health care information for patients. This is even more critical as we move toward a value-based health care system.
However, without appropriate context the data could hinder patient understanding about the value of appropriate, medically necessary health care services as recommended by their physician. The data attributes some non-physician practitioner services to the physician, but fails to make that distinction. It’s also important to note that physicians are unable to review the data and correct any errors before it is made public.
Dermatologists provide individualized care tailored to the unique needs of each patient. Factors such as age, overall health and severity of the conditions being treated are not accounted for. Many patients – such as those with psoriasis – also receive treatment right in the dermatologist’s office. The Part B data includes these treatments – and the skyrocketing price of drugs must also be considered.
Reimbursement data alone are not an indicator of high-value care. These data must be coupled with quality, outcomes, and patient experience data, as well as a specific analysis of individual physicians’ patient population and service mix, to present a more accurate reflection of value.