Insurers want to know which doctors routinely order the most services and the costliest treatments. Hospitals want to know which physicians to partner with for accountable care programs. Fraud investigators and researchers want to know who is ordering unnecessary services or billing excessively. Consumer groups and individual consumers want to know which doctors have the most experience with complex procedures.
All these groups will be closely examining HHS' massive release last week of information on 2012 Medicare Part B payments to individual physicians and other providers. The watershed publication of the long-sought data is part of what many experts see as a burgeoning new era of transparency in healthcare pricing, quality of care and use of services.
“For too long, the only information on physicians readily available to consumers was physician name, address and phone number,” Jonathan Blum, CMS principal deputy administrator, said in a written statement. “This data will, for the first time, provide a better picture of how physicians practice in the Medicare program.”
The database includes 9.2 million lines describing transactions worth $77 billion by 880,000 physicians, physician practices and other providers certified to collect from Medicare. It includes individual physicians' names and office locations, the exact services for which they billed Medicare, the average payments for each service and the number of patients who received each service. The data do not include patient identities. The CMS expects to release similar data troves on Part B payments annually.
“The insights that can be gained here are near limitless,” said Dr. Graham Hughes, chief medical officer of business-analytics firm SAS. “The focus will be on utilization, practice patterns and practice variation. I have heard directly from some of our (hospital) customers that they are poring over this data as we speak.”
The data release came over the strong objections of organized medicine, which had fought to block the release for decades, arguing that such information would violate doctors' privacy rights. “Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences,” said Dr. Ardis Dee Hoven, president of the American Medical Association. The data “will not allow patients or payers to draw meaningful conclusions about the value or quality of care.”
Media reports have highlighted the limitations of the data, such as the fact that billings listed under a single physician code may refer to all doctors in a large physician practice. In addition, billings may have included costs for expensive drugs as well as office space, nonphysician providers and other staff.