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CMS Releases Medicare Cost Data on Physicians. Now What?

By jfellows@healthleadersmedia.com  
   June 04, 2015

Data limitations don't give an accurate picture of what Medicare reimbursement really means for physicians. But patients are increasingly aware of healthcare costs, and physicians should not shy away from a conversation.

The report released this week by the Centers for Medicare and Medicaid Services detailing that over 950,000 providers were paid $90 billion for medical services they provided to Medicare beneficiaries in 2013 has spawned sensational headlines about Medicare's millionaire doctors. The headlines aren't wrong, but it's a small group of physicians that are garnering the attention of many. To prevent an inaccurate narrative, doctors may need to prepare for patients' questions.

This is the second time CMS has released physician-specific data for Medicare payments in an effort be more transparent. In a prepared statement, American Medical Association President Robert Wah, MD, commended CMS for its effort, but criticized the agency for giving so little context to what the data means for patients.


>>>CMS Releases Medicare Cost Data on Physicians

"Specifically, the data released today do not provide actionable information on the quality of care that patients and physicians can use to make any meaningful conclusions … [or] 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."

It's true that the data has many limitations. For one, there is no information that gauges quality. It also shows information only on Medicare services. Depending on the payer mix of a physician office, Medicare beneficiaries could be a minority or majority. Geographic variation in payment amounts isn't accounted for.

Despite the criticism and the limits of the data, however, CMS's broad conclusions offer some insight into patient patterns. For example, the average number of office visits was six per enrolled Medicare beneficiary. States with the highest utilization rates include Texas, Florida, New York, and New Jersey.

One major improvement in the report is that drug reimbursements are separated out from physician services. That was not the case when data for 2012 was released to the public, which falsely inflated medical services reimbursements for some specialties.

Do patients care?
Consumers are demanding more price transparency for medical services. Does this report give them that information? Not really, says Anders Gilberg, senior vice president of government affairs for Medical Group Management Association (MGMA), the national organization that represents 33,000 practice administrators who are part of 18,000 healthcare organizations.

"The value of these data to Medicare patients is indirect at best," Gilberg told me. "Unlike private health plans, physicians are paid by Medicare under a fully transparent fixed Medicare fee schedule that anyone can look up on the Internet. There is little relevance to Medicare beneficiaries between physician charges and actual Medicare payment rates, especially with the additional widespread use of Medigap plans. The information can be misleading since using data on the frequency of procedures from any single payer provides a small snapshot into a physician's practice and is not a proxy for quality."

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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