CMS Releases 2013 Medicare Payment Data for Hospitals and Physicians
June 2, 2015 - Yesterday, the Centers for Medicare and Medicaid Services (CMS) announced the release of utilization and payment data for both Medicare hospital services (inpatient and outpatient) and for physicians and suppliers. This is the third year the hospital data was released and the second year that the physician and supplier data was released. Indeed, the big troves of healthcare data keep coming. On April 30, CMS published information on 2013 Medicare Part D payments. At the end of this month, on June 30, CMS is scheduled to release the first full year of pharmaceutical and medical device transfers of value made to physicians and teaching hospitals as part of the Physician Payments Sunshine Act.
“Data transparency facilitates a vibrant health data ecosystem, promotes innovation, and leads to better informed and more engaged health care consumers,” said Niall Brennan, CMS chief data officer and director of the Office of Enterprise and Data Analytics in the accompanying press release. “CMS will continue to release the hospital and physician data on an annual basis so we can enable smarter decision making about care that is delivered in the health care system.”
Physician and Supplier Payment Data
The physician and supplier payment data (available here) consists of information on services and procedures provided to patients for over 950,000 providers who received $90 billion in Medicare payments. CMS notes that the data allows for “comparisons by physician, specialty, location, types of medical services and procedures delivered, Medicare payment, and submitted charges.”
CMS spotlighted physician specialty. As you can see from the following chart, cardiologists, for example, had higher average costs per provider for medical services in 2013 than hematology/oncologists and less than ophthalmologists. CMS, however, added an important addition to this year's dataset:
Indeed, responding to criticism last year--in which many of the top physicians in the database had the cost of expensive drugs attributed to them as essentially profits by certain news outlets--CMS this year separately outlined payments to physicians for services and for the cost of drugs. This distinction matters. The doctor who received the most from Medicare, for instance, was Anne Greist, who co-founded the Indiana Hemophilia & Thrombosis Center in 1998. "Greist received more than $28 million, but $27.9 million of it was simply passed through her to pharmaceutical companies for expensive drugs," notes USA Today.
The American Medical Association said yesterday that it is "committed to transparency that improves patient care." However, the AMA said the 2013 release, despite improvements in clarity of drug pricing, "does not provide enough context to prevent the types of inaccuracies, misinterpretations and false assertions that occurred the last time the administration released Medicare Part B claims data." We outlined additional concerns with that database here.
The top one percent of billers in 2013 received 17.5 percent of all payments in 2013, notes Nasdaq's coverage. "That same cluster of doctors and other individual providers received 16.6% of the program's payments in 2012, figures show."
Bloomberg wrote that Medicare paid at least 3,900 individual health-care providers $1 million or more in 2013. "On average, doctors were reimbursed about $74,000, though five received more than $10 million," they noted.
A number of news articles have picked out the physicians with the highest Medicare payments; see USA Today.
Hospital Utilization and Payment Data- Inpatient and Outpatient
As far as the hospital data (inpatient data available here; outpatient available here), CMS notes that “payment data consists of information for 2013 about the average amount a hospital bills for services that may be provided in an inpatient stay or outpatient visit.” The data includes information for services provided in connection with the 100 most frequently billed Medicare inpatient stays and for 30 selected outpatient procedures. The data covers more than 3,000 hospitals across the country.
According to CMS's hospital billing data, joint replacements are the most commonly performed procedure, costing $6.6 billion in 2013. Among the other most common conditions are life-threatening infections, known as septicemia, costing $5.6 billion; heart failure and shock costing about $3.5 billion; and types of pneumonia, costing about $3.8 billion. View CMS's fact sheet about this data set. Modern Healthcare has also compiled a useful chart outlining the procedures generating the most payments here.
CMS has released hospital charge data for three years now, first in 2011. This allows for a comparison of changes on a yearly basis, for example, the changes in the average charges for a given procedure. For instance, major joint replacement grew from $50,116 to $52,249 or a rate of 4.3% 2011 to 2012, and grew from $52,249 to $54,239, a rate of 3.8%, from 2012 to 2013. The data also allows for analyses of disparities and variances in what different hospitals charge for the same procedure.