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Wednesday, April 9, 2014

Medicare releases data on payments to doctors

Posted By on Wed, Apr 9, 2014 at 7:43 AM

The Center for Medicaid and Medicare Services (CMS) today released a huge trove of data containing information on procedures provided by doctors for Medicare patients and the payments they received (CMS first announced last week that this was release — it amounts to the most detailed database on doctor payments publicly released in the history of the Medicare program).

The Wall Street Journal has made this handy tool from the data allowing you to look up individual docs.

The release covers 880,000 health care providers, showing the number of visits, types of procedures and payments received under the Medicare program in the year 2012. 

As we noted last, week, this is big news for transparency in medical reimbursements. As CMS put it last week, "Providing consumers with this information will help them make more informed choices about the care they receive."

ProPublica's Charles Ornstein, who has been all over this story, has a helpful primer on why this matters in an op-ed today yesterday in the L.A. Times.

We'll have more later on what the data tells us about Arkansas (it probably gives more of a window on specialist reimbursements than we've had before publicly, an issue that was at the center of the private option debate when a group of lawmakers threatened to withhold support of the program after Blue Cross Blue Shield cut the reimbursement rate to specialists). For now, here's the data

In a separate blog post, Ornstein explains some reasons for caution in analyzing the raw data: 

There are many reasons why a doctor may receive large payments from Medicare. For one, the doctor may treat exclusively Medicare patients. In such cases, the doctor’s payments would naturally look larger compared to peers who also see a lot of privately insured patients (this is called a provider’s payer mix). Another explanation is that the doctor may provide services, such as eye surgery or cancer care, that are reimbursed at higher rates than typical office visits. A third explanation is that the provider may have other professionals billing under his/her Medicare number, which is allowed in some circumstances. Of course, there may be other reasons that raise questions of fraud, but don’t just assume that because a number is large, a doctor has done something wrong.

The New York Times story this morning focused on a small fraction of Medicare docs receiving a huge portion of the reimbursements, with the top 2 percent of health care providers earning almost a quarter of the $77 billion paid out by Medicare in 2012: 

click to enlarge nyt_2.PNG

More from the Times: 

In 2012, 100 doctors received a total of $610 million, ranging from a Florida ophthalmologist who was paid $21 million by Medicare to dozens of doctors, eye and cancer specialists chief among them, who received more than $4 million each that year. While more money by far is spent for routine office visits than any other single expenditure, one of the most heavily reimbursed procedures — costing a total of $1 billion for 143,000 patients — is for a single treatment for an eye disorder common in the elderly.

As the Times noted, this will be a treasure trove for researchers, health care plans, and regulators (including fraud investigators). In time, it could also provide valuable information for consumers of health care. As CMS stated in their release last week: 

Data like these can shine a light on how care is delivered in the Medicare program. They can help consumers compare the services provided and payments received by individual health care providers. Businesses and consumers alike can use these data to drive decision-making and reward quality, cost-effective care. We look forward to describing how this information can inform consumers and health care providers when we release this data in the near future.

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