On Wednesday, April 9, 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.
TMA President Stephen L. Brotherton fielded media calls Wednesday and told The Houston Chronicle, "There's way too little context being provided at this point to draw conclusions. I'm not saying any of the information is incorrect, but just looking at gross payments can be inflammatory and doesn't tell you what a doctor is really getting paid when all's said and done."
The data come from claims physicians submit to Medicare for payment. The data release includes:
- The number and type of health care services provided,
- Count of unique beneficiaries treated, Average submitted charges, and
- The average amount Medicare paid for those services.
CMS has more information on the data released.
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. But last May, 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.
The AMA released guidance outlining the data's nine primary limitations that people need to consider when evaluating physicians’ information. For instance, quality of care can’t be assessed from the information reported, as the disclosure is limited to claims information.
Even CMS acknowledges the limitations of the data. "[T]he information presented in this file also does not indicate the quality of care provided by individual physicians. [Because] the file only contains cost and utilization information, the volume of procedures presented may not be fully inclusive of all procedures performed by the provider. … Additionally, 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."
CMS continued to point out that "… the data in the Physician and Other Supplier [disclosure] may not be representative of a physician's entire practice. 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."
In light of the limitations of the data to which CMS admits, TMA is concerned the data could mislead the public as it is presented without context. The data 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. In Texas, Medicare covers about 3.2 million seniors and Texans with disabilities.
TMA encourages physicians to seek out and review their claims information released by CMS.
Last year, CMS released hospital data showing what hospitals charge for common inpatient and outpatient services across the country.
Special Action: April 11, 2014