CMS Data: 25% of Physicians Account for Most Medicare Spending

CMS gave the public unprecedented access to Medicare physician payment data today.

The newly released data set includes information on more than 880,000 healthcare professionals across the country who received a total of $77 billion in Medicare Part B fee-for-service payments in 2012. With the data, it's possible to compare 6,000 different types of services, procedures and payments received by individual providers, according to HHS.

The New York Times has already analyzed the data and found a small fraction of physicians account for a significant amount of Medicare spending. According to the Times, about 2 percent of physicians received about $15 billion in Medicare payments. Furthermore, only 25 percent of physicians accounted for 75 percent of Medicare spending. In 2012, 100 physicians — mainly eye and cancer specialists —received a total of $610 million from Medicare, according to the analysis.

The American Medical Association has released a statement saying that while the organization is "committed to transparency and the availability of information for patients to make informed decisions about their medical care," it has some concerns about CMS' release of physician data.

"We believe that the broad data dump today by CMS has significant short-comings regarding the accuracy and value of the medical services rendered by physicians," AMA President Ardis Dee Hoven, MD, said in the statement. "Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences."

The Medical Group Management Association also released a statement from Susan Turney, MD president and CEO of MGMA, expressing concerns about the data. "MGMA supports the constructive release of cost and quality data information to benefit Medicare beneficiaries," Dr. Turney said in the statement. "However, the decision by [CMS] to release Medicare physician claims data is problematic, and without the proper context and safeguards in place, it will be detrimental to patients and physicians."

CMS' landmark release of physician payment data builds on the agency's decision earlier this year to evaluate Freedom of Information Act, or FOIA, requests from the media on a case-by-case basis for individual Medicare payments made to physicians, effective this past March. Previously, HHS said that "considering the two competing interests of public transparency and privacy," Medicare physician data could not be provided through FOIA requests. The decision to disclose the data was spurred by a federal judge's decision last year to lift a 1979 injunction that barred the release of individual physicians' annual Medicare payments. That court decision stems from a January 2011 request from Dow Jones, publisher of The Wall Street Journal.

Last year, HHS and CMS also released hospital charge data for the 100 most common inpatient services and 30 most common outpatient services.

More Articles on Healthcare Cost Transparency:
CMS to Release Physician Payment Data
7 Predictions on Medicare's Release of Physician Payment Data
CMS Extends Transparency Movement to Physician Payment

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