Ever wonder how much your doctor gets paid for taking care of you?
In an unprecedented move, the federal government on Wednesday released information about Medicare payments to hundreds of thousands of physicians and other individual health-care providers and practices.
The Centers for Medicare & Medicaid Services (CMS) released the massive data file on its website as part of an overall push to give the public more information about the cost and quality of health-care services, said Jonathan Blum, CMS’ principal deputy administrator.
“We believe the public has the right to know,” Blum said. “The Medicare program is, by and large, funded with taxpayer dollars and taxpayers have the right to understand what is being paid for and how it’s being paid for.”
The American Medical Association and other physician associations fought for decades to keep doctor payment amounts from being released. A court ruling cleared the way for the information to be made public.
The data includes doctors’ names and addresses, the number of exact services they provided and average amount they received for each patient visit or service from Medicare, the federal health program for people ages 65 and older and some younger disabled Americans.
The database also includes the amount doctors and physician practices charge, which typically is much higher than the amount Medicare actually pays.
The information covers more than 880,000 health-care providers nationwide who collectively received $77 billion in Medicare payments in 2012.
The data doesn’t include any patient information. To protect patient privacy, CMS also kept out payment amounts to doctors if fewer than 11 Medicare recipients received the service.
In a prepared statement, Dr. Brent Mulgrew, executive director of the Ohio State Medical Association, said: “If the goal is to provide payment transparency to ultimately improve quality care outcomes, then the release of this data arrives with good intentions but is incomplete and unfortunately may lead to more questions than it answers.
“The data that has been made available comes with no discernible context which likely will lead to inaccurate interpretations of what the data truly represents,” he said. “Without proper analysis or context, the numbers are difficult to understand and place in proper perspective. For example, it should be noted that more than one provider can submit bills under a single physician’s account for a service rendered, thus portraying an unusually high service volume which may not be true.”
The highest average Medicare payments in 2012 went to hematology/oncology specialists, according to CMS. A total of 7,373 cancer doctors nationwide were paid an average $463,844, which included reimbursement for costly chemotherapy drugs.
The database could potentially be used to determine which doctors are ordering more tests and procedures than the average, said J.B. Silvers, director of research at Case Western Reserve University’s Health Systems Management Center in Cleveland.
The Associated Press reported on Wednesday that the Medicare claims database showed just 344 doctors out of 825,000 were paid at least $3 million each, for a total of nearly $1.5 billion.
Patient benefit
As the database is analyzed and potential abuses are found, Silvers said, patients could benefit from the knowledge, particularly as they’re being forced to pay a larger part of their health-care bills.
“If somebody is overusing services for Medicare, there’s a pretty good chance they’re going to be overusing it for commercial plans, too,” Silvers said.
The government is encouraging researchers and others “to help us with this data, to find outliers and patterns of spending that appear not to be in the beneficiaries’ interests or taxpayers’ interests,” Blum said.
The information also could potentially be used by insurers, which could add the Medicare data to their own claims information to show trends in costs and services provided, said Thomas S. Campanella, director of the Health Care MBA at Baldwin Wallace University.
The Medicare physician payment data is available online at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other-Supplier.html
Cheryl Powell can be reached at 330-996-3902 or cpowell@thebeaconjournal.com.