CMS releases new physician, hospital payment data

Newly released data from the Centers for Medicare & Medicaid Services (CMS) show that Medicare reimbursements to doctors are far from evenly distributed, while hospital charges for top procedures and conditions have increased moderately.

The Medicare Part B data tracks 2013 information for more than 950,000 providers who received $90 billion in Medicare payments. CMS' first annual release of provider payments last year indicated Medicare paid individual physicians more than $60 billion in 2012.

CMS paid approximately 3,900 physicians at least $1 million in 2013, a Bloomberg analysis found, with five receiving more than $10 million. The average reimbursement came to about $74,000. Numerous physicians opposed the data release last year, with the American Medical Association (AMA) warning the data lacked context and would lead to misinterpretations by the public, FierceHealthFinance has reported. 

The AMA credited CMS for clarifying the 2013 data by grouping Part B drugs and payment for physician services separately, but still had concerns. "Specifically, the data released today does not provide actionable information on the quality of care that patients and physicians can use to make any meaningful conclusions," AMA President Robert Wah, M.D., said in a statement to press. "It also does not provide enough context to prevent the types of inaccuracies, misinterpretations and false assertions that occurred the last time the administration released Medicare Part B claims data."

The hospital payment data, meanwhile, compiles average hospital billing amounts for inpatient and outpatient services for 2013. This includes use and payment data regarding care for the 100 most frequent Medicare inpatient stays, which represent more than 7 million hospital discharges and $62 billion worth of Medicare payments, as well as 30 selected outpatient procedures.

Now that CMS has three years of data to analyze, it is able to identify trends in hospital payments, charges and usage, according to a fact sheet about the data. In general, the data show that charges for the top Medicare Severity Diagnosis Related Groups--for example major joint replacement procedures--"increased over time at a modest rate," the fact sheet states.

President Barack Obama's administration recently announced a timeline and set of goals to transition from volume-based care to value-based care, and released the data as part of a broader set of initiatives to incentivize higher-quality care, reduced spending and better outcomes, according to the announcement.

"Data transparency facilitates a vibrant health data ecosystem, promotes innovation, and leads to better informed and more engaged healthcare consumers," said Niall Brennan, CMS chief data officer and director of the Office of Enterprise and Data Analytics. "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 healthcare system."

To learn more:
- here's the announcement
- here's the fact sheet
- read the inpatient data
- read the outpatient data
- check out the physician data
- read the Bloomberg analysis

 

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