CMS Releases 2014 Payment Data

Date: May 14, 2016

Earlier this week, CMS posted the Medicare provider utilization and payment data from 2014.  The release of annual data began in 2014 as part of President Obama’s “transparency” initiative.  When the 2012 data was released in 2014, it created headlines and major news stories.  Ophthalmology was targeted aggressively since the provider with the highest reimbursements was an ophthalmologist.

It is important to note that the file only includes claims data for patients enrolled in traditional fee-for-service Medicare.  This is not a true representation of a physician’s entire patient population.  CMS acknowledges limitations with the data.  Corcoran Consulting Group notes the following limitations:

  • Subspecialties aren’t identified
  • Errors were not corrected
  • Geographic differences remain unadjusted
  • Quality of care is not addressed
  • Reason for service is not identified
  • No risk adjustment for severe, chronic diseases
  • Effect of modifiers skews the data

The initial release of data in 2014 included covered Part B drugs, which inflated reimbursements for physicians who provide these drugs to patients.  In ophthalmology, retina provider reimbursements were grossly inflated due to drugs.  This error was corrected in 2015 for the 2013 data, and drugs were carved out.

The data can be useful to you in many ways.  For example:

  • Marketing and advertising
  • Identify referral sources
  • Identify providers similar to you
  • Identify the largest providers
  • Identify changes over time

Additional information and access to the data can be found at:

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other-Supplier2014.html

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