SummaryOn April 9, CMS released cost and utilization data on services provided to Medicare fee-for-service (FFS) beneficiaries by physicians and other healthcare professionals in calendar year (CY) 2012.
The data includes more than 880,000 unique providers, including individual physicians and non-physician practitioners as well as organizations such as pharmacies, laboratories, imaging facilities or ambulatory surgical centers (ASCs). This publicly available dataset contains information on the number of services, number of unique beneficiaries, charges submitted by provider, payments from Medicare as well as provider characteristics such as name, address and specialty.
With this new data, the public can determine which physicians received significant Medicare payments for services that can be distinctly tied to specific products. While it is possible that several physicians may be billing under a single number, thus making it appear that some physicians received abnormal payments while others received none, the general public may not understand this billing nuance. Manufacturers should be prepared to respond to queries from the press about billing patterns of particular physicians.
It also is now possible to examine the billing patterns of specific physicians in specific geographies. However, it is not possible to link the physician data to other types of providers, including hospitals or nursing homes. In addition, many seemingly abnormal billing patterns could be explained by factors that cannot be determined in the summary files. As such, groups will be limited in their ability to use this data to advance payment reform discussions.
This highly anticipated data release is likely to spur a lot of discussion around physician utilization and billing patterns. CMS has suggested that the file may help the public identify fraud and abuse, although it is unclear how successful these efforts will be given some of the limitations of the summary file.
The release of this data is yet another step in CMS’ continuous effort to make the Medicare program more transparent by making more data available for public use. Nevertheless, CMS cautions about linking the newly released data to other publicly available datasets and to Medicare claims datasets available to researchers partly due to potential distortions that can occur on the individual provider level.
View CMS’ data set and press release.