On April 11 the Centers for Medicare & Medicaid Services publicly released data on $77 billion in payments made to 880,000 physicians in 2012. To access this data, you can go to the CMS Medicare Provider Utilization and Payment Data website. The disclosure provides a list of procedures performed by individual physicians, what physicians charged and what Medicare reimbursed for the procedures. This is consistent with CMS’ efforts to expand transparency of quality and cost information as well as promote a wide range of analyses comparing 6,000 different services and procedures provided and their payment.
The new physician data files contain information on utilization, payment (allowed amount and Medicare payment) and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. The data sets do not contain any information on quality.
An article in today’s front page of the New York Times focuses on how these data may be used to identify cases of fraud and abuse or controversial areas of spending. You can expect your local media to look into these data and potentially contact your hospitals and health systems about what was released on individual physicians. It would benefit your organization to:
- Notify your physicians in your hospital and health system that the Medicare data has been released and is being accessed by the public, including the media
- Suggest your physicians review their own data
- Review data on your physicians for any outliers that may be flagged by the media
- Be prepared to respond to public inquiries into reimbursement levels for individual physicians, specific procedures and sites of service