CMS Releases Data on Medicare Providers’ Fees, Services to Mixed Reviews

Reaction to CMS’ public online release of data on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals has been mixed.

Specifically, the data released last week includes physicians’ names and addresses, summaries of the services provided, and amounts providers were paid for the services.

Overall, the data show that Medicare paid out $77 billion to more than 880,000 healthcare providers in 2012, including $12 billion for about 214 million office and outpatient visits, according to the New York Times. The top 1 percent of 825,000 individual medical providers accounted for 14 percent of the $77 billion in billing recorded in the data.

Other key points from the report includes the following:

  • Medicare paid 344 physicians and other health providers more than $3 million each in 2012.
  • Collectively, the 1,000 highest-paid Medicare doctors received $3.05 billion in payments.
  • One-third of those top-earning providers are ophthalmologists, and one in 10 are radiation oncologists.

Reaction to the data release has been mixed. Says the American Medical Association (AMA), “We believe that the broad data dump by CMS has significant shortcomings regarding the accuracy and value of the medical services rendered by physicians. Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences, added the AMA.

“Thoughtful observers concluded long ago that payments or costs were not the only metric to evaluate medical care. Quality, value and outcomes are critical yardsticks for patients. The information released by CMS will not allow patients or payers to draw meaningful conclusions about the value or quality of care.”

Source: CMS, New York Times, AMA, April 9, 2014

Bundled Payments: Opportunities in Effective Retrospective Acute and Post Acute Care Bundles

Bundled Payments: Opportunities in Effective Retrospective Acute and Post Acute Care Bundles share the first quarter experiences from two pilot programs, along with the current bundled payment opportunities for organizations not yet participating in CMMI’s pilot program.

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