Historic Release of Medicare Provider Utilization and Payment Data

After years of pressure from consumer groups and new outlets, and with the AMA court injunction lifted, the Center for Medicare Services released data this week on what Medicare paid individual doctors in 2012. The historical release of data is the first time this information has been available to the public since the 1970s. It represents the first step in the Obama Administration’s efforts to make our health system more transparent, accountable and affordable.

The data includes information for the 100 most common inpatient services, 30 most common outpatient services, and all physician andCMS Payments other supplier procedures and services performed on 11 or more Medicare beneficiaries.

The American Medical Association and other physician groups have resisted the data release, arguing that the information violates doctor privacy and that the public may misconstrue details about individual doctors.  By releasing the data, Medicare officials said they hope the data will expose fraud, inform consumers and lead to improvements in care.

The government insurance program for older people paid nearly 4,000 physicians in excess of $1 million each in 2012, according to the new data. Those figures do not include what the doctors billed private insurance firms.  Among the highest billers were: a cardiologist in Ocala, Fla., who took in $18.1 million, mainly putting in stents; a New Jersey pathologist who received $12.6 million performing tissue exams and other tests; and a Michigan vascular surgeon who got $10.1 million.  Some of the highest billing totals may reflect:

  • A physician who is extremely efficient
  • Physicians with an unusually large number of Medicare patients
  • Fraudulent doctor behavior
  • Medicare payments for some procedures being too high for the amount of work involved
  • Perverse incentives that lead doctors to overuse a procedure

"Data transparency is a key aspect of transformation of the health care delivery system,” said CMS Administrator Marilyn Tavenner. “While there’s more work ahead, this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program.”

Last May, CMS released hospital charge data allowing consumers to compare what hospitals charge for common inpatient and outpatient services across the country.

For information about the data, visit CMS’s Frequently Asked Questions page.

For information about Inpatient Data, visit:  Medicare Provider Utilization and Payment Data: Inpatient

For information about Outpatient Data, visit: Medicare Provider Utilization and Payment Data: Outpatient

 

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