By David Pittman, Washington Correspondent, MedPage Today
WASHINGTON — APRIL 9, 2014 — For the first time, totals of what Medicare pays individual healthcare providers is now freely available to download and browse on a government website.
Patients, other healthcare providers, journalists, and anybody else willing to sift through an Excel spreadsheet nearly 900,000 rows deep can discover what each physician, nurse practitioner, and other professional who billed Medicare Part B earned from the program in 2012.
The Centers for Medicare and Medicaid Services (CMS) released the information early Wednesday after a long legal battle to make the data public and hopefulness by the Obama administration that the information will lead to wiser healthcare consumers.
CMS actually released two spreadsheets. The first one lists more than 880,000 providers by name, address, national provider identifier, specialty, number of Medicare patients, number of services billed, submitted charges, and — most importantly for the voyeurs — the total Medicare payment.
The second spreadsheet provides a breakdown of common Medicare services and procedures, the number of providers administering it, the number of times it was performed, the number of patients it was given to, and the total amount Medicare paid.
The information came over the verbal protests of the American Medical Association, who opted not to file a last-minute lawsuit to prevent Wednesday’s release.
“Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences,” AMA President Ardis Dee Hoven, MD, said in a release. “The AMA is disappointed that CMS did not include reasonable safeguards that would help the public understand the limitations of this data.”
Some news organizations have already dived headfirst into the data, publishing stories on the nearly 4,000 physicians who received more than $1 million from Medicare in 2012. For instance, Medicare paid Florida ophthalmologist Salomon Melgen, MD, almost $21 million in that year.
The release follows a federal court decision in Florida last year that overturned a more-than-30-year-old injunction preventing the release of information detailing what Medicare pays individual doctors.
CMS initially said it would release the payment data on a “case-by-case” basis starting this spring, but after a large number of requests, decided to release the data to the general public on its website. The agency notified the AMA of its decision in a letter last week.
The data does not include payments made under Medicare Advantage. It also doesn’t include personally identifiable patient information about procedures performed on fewer than 11 patients.
The AMA cautioned the public about making too many early conclusions about the payment information including that payment amounts vary by where a service was provided.
“Medicare pays physicians less for services provided in a hospital outpatient department than for services provided in the physician’s office to reflect a difference in the practice costs,” the organization wrote Tuesday in its AMA Wire.
The Association of Health Care Journalists, in a blog post Tuesday written by immediate past president Charlie Ornstein of ProPublica, cautioned reporters on a number of similar issues including that physicians have a different “payer mix”, see a different number of Medicare patients, and some have other professionals billing under their name.
Those issues may make it appear as if one physician receives a great deal more from Medicare than their colleague down the street.
Data journalist Fred Trotter noted that for the first time the public can verify the effectiveness of CPT codes and the controversial Relative Value Units (RVU) process, which combined determine how much physicians get paid for what procedures.
Complaints against them is that they undervalue some services and overvalue others to the point where some physicians can make it appear as if they work more than 24 hours in a day because the RVU process overestimates the time it takes to perform some procedures.
“I cannot imagine that anyone other than the AMA believes that the CPT/RVU scheme is actually working well, but for the first time, we can quantify and categorize the problem,” Trotter wrote on his blog. “That is the first step on the road to something better.”