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HHS releases Medicare provider payment data

In what it calls a historic release giving consumers “unprecedented transparency,” the U.S. Department of Health & Human Services has just released data on services and procedures provided to Medicare beneficiaries by physicians and other health care professionals.

“Currently, consumers have limited information about how physicians and other health care professionals practice medicine,” HHS Secretary Kathleen Sebelius said in a news release. “This data will help fill that gap by offering insight into the Medicare portion of a physician’s practice. The data released today afford researchers, policymakers and the public a new window into health care spending and physician practice patterns.”
The new data set has information for more than 880,000 health care providers who collectively received $77 billion in Medicare payments in 2012, under the Medicare Part B Fee-For-Service program. It does not have information for institutional health care providers, such as hospitals or nursing homes, or for suppliers of durable medical equipment, but HHS noted that some data on these types of providers is already publicly available.
For each provider and service, the new data set has the total number of services that were furnished, the provider’s average charge, the average Medicare payment, and the average Medicare-allowed amount, which is the sum of Medicare’s payment and any deductible or coinsurance owed by the beneficiary.
The American Medical Association has released a cautionary statement and guidance on interpreting the data.
“Medicare claims data is complex and can be confusing,” it said in a statement to reporters. “The manner in which CMS is broadly releasing physician claims data, without context, can lead to inaccuracies, misinterpretations and false conclusions.”

Heather Stauffer

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