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AMA Urges Caution with Medicare Doctor Data

Christopher Cheney, for HealthLeaders Media, April 10, 2014

The American Medical Association says the public should exercise caution when interpreting the 2012 Medicare payment data for physicians, saying "the manner in which CMS is broadly releasing physician claims data, without context, can lead to inaccuracies, misinterpretations and false conclusions."

The American Medical Association is urging members of the public to exercise caution when interpreting the 2012 Medicare payment data for physicians released by the Centers for Medicare & Medicaid Services early Wednesday.


Release of Medicare Pay Data for Physicians Sparks AMA Concerns


Soon after the data was made available on the CMS website, the AMA released its "Guide to Media Reporting on CMS' Medicare Physician Claims Data," featuring this stern warning to anyone attempting an analysis: "Medicare claims data is complex and can be confusing and the manner in which CMS is broadly releasing physician claims data, without context, can lead to inaccuracies, misinterpretations and false conclusions."

The guide cautions anyone trying to analyze the claims data about several potential pitfalls:

  • Data errors are possible because "there is currently no mechanism for physicians and other providers to review and correct their information."
  • The data does not measure quality because it "solely focuses on payment and utilization of services so it cannot be used to evaluate the value of care provided."
  • The data may not accurately reflect Medicare payments to an individual doctor because many residents, physician assistants, nurse practitioners and others under the doctor's supervision can all file claims under that physician's National Provider Identifier number. 
  • The data is an incomplete representation of the services physicians provide because it is not risk-adjusted to reflect the overall health of a doctor's patient population.
  • Payment amounts vary based on where a service was provided.

In a statement issued Tuesday night before the data was released, Ardis Dee Hoven MD, president of the AMA, said the impact of making raw Medicare claims data public would not be positive.

"We think that the data dump will likely lead to a lot of confusion and misrepresentations," she said. "There are a number of steps that were not taken to overcome and clarify the limitations of the data to make it helpful, accurate, complete and clear."


Christopher Cheney is health plans editor at HealthLeaders Media.

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