Use the CMS Medicare payment database to see how your physician practice measures up

Doctors can learn a lot about their own practice patterns from a government database.

Doctors can use a government database to compare their practice patterns to others across the nation, says a former Wall Street trader turned physician.

The database, maintained by the Centers for Medicare & Medicaid Services (CMS) includes annual data on payment patterns and reimbursement to individual physicians since 2014, wrote the doctor, who blogs under the pen name “The Wall Street Physician.”

Doctors can use those figures, which are part of what’s officially called the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File, he wrote in a post on KevinMD.

Free Daily Newsletter

Like this story? Subscribe to FierceHealthcare!

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

It allows doctors to compare their practice patterns to other practitioners. For example, doctors can look at the distribution of follow-up office visits among internal medicine specialists based on complexity. If most internists are billing at a level 4, doctors who are billing most of their follow-up visits at a lower level can look at their documentation and see whether they should receive a higher reimbursement by billing and documenting differently, he wrote.

The Medicare dataset may also help keep doctors honest. It can help identify suspicious billing patterns and allow researchers, the media and the public to identify outliers in practice patterns, he said.

RELATED: Study finds 1 in 12 doctors received payments from opioid makers that totaled $46M

Keep in mind, the database has limitations, including that if the data is not used carefully, doctors can make incorrect conclusions, he advised. And the data only includes Medicare patients, so you won’t find much information on pediatricians.

Another limit is the dataset does not account for the overhead costs of delivering procedures, he said. So specialists such as radiation oncologists who perform a lot of high-overhead procedures will have higher Medicare reimbursements than physicians who mostly bill for office visits.

Although opening up the database to the public was controversial and opposed by the American Medical Association, the Wall Street Physician said that if interpreted correctly, it provides a valuable service to the public.

Suggested Articles

A new study takes a look at how the U.S. stacks up to other developed countries on healthcare and social spending.

While it continues to oppose “Medicare for All,” the American Medical Association has dropped out of a coalition organized to fight the proposal.

Healthcare costs for families with employer coverage have risen twice as fast as wagesover the past decade, according to a new report.