June 08, 2015
Area(s) of Interest: Payor Issues and Reimbursement Practice Management Public Payors
The Centers for Medicare and Medicaid Services (CMS) has released the details of how much physicians were paid under Medicare Part B fee-for-service for 2013, as well as how much hospitals billed and received for inpatient and outpatient care. The agency released the physician and hospital payment data last year as well.
In the past, CMS data has only been available to researchers who did not intend to develop commercial products. The agency is now inviting innovators and entrepreneurs to take a look and help improve patient care, said CMS Acting Administrator Andy Slavitt. “We do this with the clear expectation that you will create new streams of tools to improve care,” he stated at the Health Datapalooza conference in Washington, D.C., where the data sets were unveiled.
The 2013 data released includes payments to more than 950,000 distinct providers who collectively received $90 billion in reimbursements. Physicians averaged $74,000 in payments from Medicare, but there were 3,900 individual physicians who were paid more than a $1 million, as well as five physicians who were paid more than $10 million.
In September, CMS announced it will begin accepting research proposals using the data sets, which identify the providers but not the patients. Researchers and entrepreneurs will have direct access to these data files and will be able to analyze them within a secure CMS environment. They will also be able to download aggregated, privacy-protected reports and results to their own personal workstations. The CMS acting head asked entrepreneurs to use the data “to build products and services that help us take care of the sickest and most difficult to treat people.”
The California Medical Association (CMA) is committed to ensuring patients and physicians have access to the data they need to make informed medical decisions. CMA is concerned, however, that the 2013 data has significant shortcomings by not including quality of care and outcomes, thus making it impossible for researchers and private businesses to draw meaningful conclusions. The data sets also provide no context with the data to prevent the type of inaccuracies, misinterpretations and false assertions that occurred the last time this type of data was released. For instance, though costs may be attributed to one physician’s identification number, they may represent a number of mid-level providers’ billings as well. CMA will continue to urge CMS to improve upon the information it releases to help researchers build a true picture of health outcomes and expenditures.
CMA is also concerned with the extent to which new tools and reports from third-parties may impose administrative burdens and related costs on physicians, especially with the increased data release frequency from annually to quarterly. Physicians may be asked to review their data and ratings, among other potential work products from those using the Medicare data, for accuracy and completeness. Furthermore, at this time, there appear to be few, if any, requirements on the manner in which these third-parties present materials to physicians for their review.
As the stakes for physicians get higher with regards to their Medicare quality and cost data, CMA strongly encourages physicians to take the time to ensure that the data being reported to CMS is accurate and complete. This may reduce the burdens of reviewing the data and any related work products from other parties in the future. CMA will continue to advocate for this data to be handled in a way that ensures minimal burden to physicians while presenting an accurate picture of the cost and quality of a physician’s practice. We hope to provide future updates on this new data release program as details continue to emerge.
Click here to view a CMS fact sheet on the physician data.
The American Medical Association has also published a fact sheet on the Medicare Data release. The information includes how physicians can look up their data and what’s in it.