CMS releases unprecedented provider utilization and payment data

On Wednesday, April 9, the Centers for Medicare & Medicaid Services published 2012 Medicare provider utilization and payment data. The release includes data for over 880,000 distinct health care providers, who collectively received $77 billion for Medicare Part B services provied in 2012. The data are available in a series of Excel files housed on the CMS website organized by provider last name. Providers are encouraged to review their own data and should be aware that this data is now publically available. The New York Times has created a searchable database of the Medicare data, a service that other news outlets also may provide in the coming weeks.  

In a U.S. Department of Health and Human Services press release, HHS Secretary Kathleen Sebelius announced, “The data released today afford researchers, policymakers and the public a new window into health care spending and physician practice patterns.” However, provider advocates have expressed concerns about such a broad release of data without mechanisms for providers to confirm its accuracy. The American Medical Association released a list of nine guidelines for media reporting on CMS claims data. The AMA highlights that the data do not include information about the quality of services provided and do not capture patient mix or demographics. 

Despite these concerns, a number of media outlets received early access to the data and published articles showing the significant variability in Medicare billing among specialties. For example, analysis by the Wall Street Journal indicates ophthalmology and oncology specialties received the highest average Medicare payments in 2012, with hematology/oncology providers receiving an average of $366,377 per provider. The New York Times reported that a single Florida ophthalmologist earned $21 million in Medicare billing in 2012.

The AASM will continue to monitor coverage of the data release and will notify members of any new developments that may impact the practice of sleep medicine.

2014-04-10T00:00:00+00:00 April 10th, 2014|Clinical Resources|