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Life Health > Health Insurance > Medicare Planning

CMS may post more physician pay data

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(Bloomberg) — Doctors are denouncing the accuracy and value of data listing $77 billion in 2012 Medicare program payments to 880,000 Medicare providers.

Consumer and many interest groups are saying the data release could make the U.S. health-care system more cost-effective.

The Centers for Medicare & Medicaid Services (CMS) – the agency that posted the 2012 payment data – is pointing out that it has plenty of other data where that came from.

CMS officials are suggesting that they might follow up on the 2012 payment data report by providing comparable information for payments made in earlier years.

The 2012 pay data report listed about 4,000 doctors and medical providers who received more than $1 million in Medicare revenue in 2012, including seven who received more than $10 million each in Medicare revenue.

Releasing data from earlier years could help regulators and consumers track how Medicare payment patterns have changed over time.

In six to eight weeks, Medicare will release a database of 2012 payments to hospitals and clinics, the second time this information has been made public for medical institutions, according to Niall Brennan, acting director of the CMS data unit.

The agency released information in May 2013 showing that hospitals often charge prices that can vary by thousands of dollars for the same procedures, even within the same towns.

Hospitals questioned the disclosure of hospital-specific price data, saying the prices don’t reflect what they’re really paid by Medicare or other insurers.

The American Medical Association, which fought to keep the physician pay information private, has similar complaints about the 2012 physician pay data report.

Some doctors may make more than the average because they see a disproportionately high number of elderly, or because they have special expertise in a certain area or better outcomes, said Ardis Dee Hoven, who leads the Chicago-based group that is the nation’s largest physician organization.

That’s not reflected in the raw data reported, potentially opening doctors to unfair criticism that may hurt their reputation and practice, she said by telephone.

Public and private payers say the pay reports could help hold down health care costs.

The physician pay report may help get private researchers and the public involved in ferreting out misuse of services and fraud in Medicare, the government health program for the elderly and disabled, Jonathan Blum, principal deputy administrator at the U.S. Centers for Medicare and Medicaid, said in a call yesterday.

“We know there’s waste in the system,” Blum said. “We know there’s fraud in the system. While we’ve made tremendous investments to reduce that fraud, we want the public’s help to identify spending that doesn’t make sense, that appears to be wasteful, that appears to be fraudulent.”

“We’ll never get health-care costs under control if we don’t have data about the factors driving that cost growth,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans (AHIP).

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