Apr. 9—The Obama administration released data on Medicare payments in 2012 to more than 880,000 physicians Wednesday, drawing concerns from provider groups.

The first-time release of detailed physician payments came as part of the administration's ongoing healthcare spending transparency initiative, which was behind its previous release of FY11 hospital charge data via the Centers for Medicare & Medicaid Services (CMS) in May 2013. Within two months, CMS plans to release FY12 hospital charge data, said Jonathan Blum, deputy administrator of CMS.

The new physician data showed payment and submitted charges for about 6,000 different services provided by each physician or other provider.

Blum said in a Wednesday call with reporters that CMS hopes the data allow the media and public to ask questions about whether geographic variation in providers' payments and number of services is justified.

"There are pockets of high spending in every state," he said. "It could be wasteful or it could be justified."

The information release will allow comparisons by physician, specialty, location, the types of medical service and procedures delivered, Medicare payment, and submitted charges, according to a CMS statement.  

Concerns Raised

The physician charge and payment data release drew similar concerns from physician advocates that hospital advocates raised when their Medicare charge data were released in 2013. The primary concern was that there was no context provided for the charges, which could lead to inaccurate assumptions about why some physicians received more Medicare payments.

"We believe that the broad data dump today by CMS has significant shortcomings regarding the accuracy and value of the medical services rendered by physicians," Ardis Dee Hoven, MD, president of the American Medical Association, said in a written statement. "Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences."

In addition to payments or costs, evaluating medical care requires quality, value, and outcomes data, she said.

"The information released by CMS will not allow patients or payers to draw meaningful conclusions about the value or quality of care," Hoven said.

In response to physician criticism that some of the data is inaccurate, Niall Brennan, acting director of the Offices of Enterprise Management at CMS, said he was "quite confident" it was correct. He also warned physicians that they are required to return any overpayments identified in the data, which is based on settled charges.

CMS officials urged "caution" before attributing high spending on particular providers to waste, fraud, or abuse. For example, Blum said high payments to ophthalmologists and oncologists are likely due to the high cost of the drugs they administer. Medicare pays the average sale price plus 6 percent for clinician-administered drugs. However, he encouraged reporters and the public to raise questions about whether physicians were using available lower cost medications of similar quality, which cost both Medicare and beneficiaries more. 

Scrutiny Ongoing

Blum also confirmed that Medicare uses an undisclosed dollar amount of total billing by clinicians to trigger greater fraud scrutiny.

Analyses of the clinician payment data by CMS has revealed that more allied health workers, such as nurse practitioners and physician assistants, are using physicians’ Medicare identification numbers to bill the program than are allowed under the law. Medicare rules allow clinicians practicing under the supervision of a physician to bill under that physician's identifier.

The data release did not include Medicare payments for facility fees. 

Rich Daly is a senior writer/editor in HFMA's Washington, D.C., office. Follow Rich on Twitter @rdalyhealthcare.



Publication Date: Wednesday, April 09, 2014