CMS Data Release and Transparency in the Health Care System

Last Wednesday, the Centers for Medicare & Medicaid Services (CMS) gave the public unprecedented access to physician payments and charges for services and procedures provided to Medicare beneficiaries. The CMS online database contains information on more than 880,000 physicians and other health care professionals who collectively received $77 billion in Medicare Part B payments in 2012.

“The North Carolina Medical Society (NCMS) recognizes the need for and supports access to physician data from all payer sources, not just Medicare, to improve transparency and quality of care,” said NCMS CEO Robert Seligson. “To truly reform our health care system, we believe sharing of data is crucial, but this information cannot be disclosed in a vacuum. The data is only useful if assurances of its accuracy are in place and patients are aware of its limitations. Consumers deserve meaningful ‘apples to apples’ comparisons in order to make informed decisions.”

“Without complete information, patients could potentially make inappropriate and possibly harmful treatment decisions. We would encourage all sectors of the health care system, including private payers and hospitals, to embrace true cost transparency in order for patients to make educated decisions about their care.”

The NCMS recommends that physicians review the data released by CMS last week. The database can be accessed here. Also, please be aware of the data’s limitations in order to help educate patients, who may have questions or concerns. For instance, quality of care can’t be assessed from the information reported, as the disclosure is limited to claims information.  The numbers also don’t account for physician expenses, such as drug and medical supply acquisition costs, investments in health information technology and other expenses associated with operating any small business. Consumers accessing the data likely don’t realize Medicare pays on average 61 percent of physicians’ overall costs.

The AMA has released guidance outlining the data’s nine primary limitations to consider when evaluating physicians’ information.

Even CMS acknowledges the limitations of the data. “The data are not risk adjusted and thus do not account for difference in the underlying severity of disease of patient populations treated by providers. …The data in the file only has information for Medicare beneficiaries with Part B [fee for service] coverage, but physicians typically treat many other patients who do not have that form of coverage. Also, since the data presented are summarized from actual claims received from providers and no attempts were made to modify any data (i.e., no statistical outliers were removed or truncated), in rare instances the average submitted charge amount may reflect errors included on claims submitted by providers.”

CMS has more information on the data released.

While the Affordable Care Act requires disclosure of data to certain qualified entities, organized medicine fought the data release in court for more than 30 years. Last May, however, a Florida federal district court lifted a permanent injunction originally issued in 1979 that prohibited the government from disclosing annual Medicare payments to individual physicians.

CMS said in an April 2 letter to the American Medical Association that the release is required under the Freedom of Information Act.

“The data to be released would assist the public’s understanding of Medicare fraud, waste and abuse, as well as shed light on payments to physicians for services furnished to Medicare beneficiaries, which are governed by statutory requirements that CMS must follow,” CMS wrote.

In North Carolina Medicare covers 1.6 million citizens, according to the Kaiser Family Foundation figures for 2012, the year for the latest data release.


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