This article is more than 5 years old. Information may no longer be current.
CMS releases new Medicare Part B reimbursement data
Click Here to Manage Email Alerts
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
Perspective
Back to Top
Raj D. Rao, MD
There are some interesting facts in the released Medicare provider data. These include that $17 billion of the $90 billion provider expenditure was on drugs; 10 of the top 20 highest paid physicians in Medicare were ophthalmologists; sports medicine and psychiatric care received more Medicare money compared to prior data, while general practitioners received less money this time.
CMS sees the release of this data as providing greater transparency and thereby improving quality of patient care. In actuality, the data likely does neither. Certainly, the data identifies recipients of huge payments and this may help identify areas that need to be scrutinized further. But, overall, the data available is incomplete and does not reflect the physician's care, competence or compassion. Rather than being "healers," physicians will be increasingly seen as providers of a commodity. It perpetuates the implications that good patient healing can be effectively monitored with spreadsheets and data accumulation.
Click Here to Manage Email Alerts