2013 Provider Billing Data Posted

On June 1, CMS announced that it has posted 2013 data on billing and services of clinicians, covering over 950,000 health care providers and $90 billion in Medicare payments. The data enable comparisons by physician, specialty, location, types of medical services and procedures delivered, Medicare payment, and submitted charges.  This second data release is one of the transparency initiatives aimed at achieving better care and smarter spending.  The first annual release last year posted 2012 data.

A June 1 AMA Wire post suggests points that physicians might use to provide context in response to questions from patients or reporters about their data.

Researchers Allowed Direct Access to Data

Also in June, CMS announced a new policy that for the first time will allow innovators and entrepreneurs to access CMS data, such as Medicare claims. As part of a goal to use data to drive transformation of the healthcare delivery system, CMS will allow innovators and entrepreneurs to conduct approved research that will hopefully improve patient care. The data will not allow the patient’s identity to be determined, but will provide the identity of the provider. CMS will begin accepting innovator research requests in September.

Researchers will access data via the CMS Virtual Research Data Center, which provides access to granular CMS program data, including Medicare Fee-For-Service claims data. Researchers have direct access to approved, privacy-protected data files and are able to conduct analyses within a secure CMS environment.  Even though all data is privacy-protected, researchers also will not be allowed to remove patient-level data.  They will only be able to download aggregated, privacy-protected reports and results to their own computers.  They will be allowed to request data on a quarterly basis, rather than the annual updates that were available in the past.

2013 Part D Prescription Spending

On April 30, Medicare officials announced the release of data on drugs prescribed to Medicare beneficiaries in 2013.  The new dataset identifies providers using their National Provider Identifier (NPI) and the specific prescriptions that were dispensed on their behalf, listed by brand name (if applicable) and generic name.  For each prescriber and drug, the dataset includes the total number of prescriptions that were dispensed (original prescriptions and any refills), and the total drug cost. The data include information about 36 million patients, one million prescribers and $103 billion in spending on drugs under Part D.  The Wall Street Journal compiled a list of the top 100 drugs by total cost, which includes two psychiatric drugs among the top five.  According to Forbes, the data do not take into account rebates paid by drug companies.

CMS notes that the dataset has a number of limitations.  Of particular importance is the fact that the data may not be representative of a physician’s entire practice or all of Medicare as it only includes information on beneficiaries enrolled in the Medicare Part D prescription drug program (i.e., approximately two-thirds of all Medicare beneficiaries).  In addition, the data are not intended to indicate the quality of care provided.  AMA President Robert Wah, MD, said in a statement, “We are also troubled by the lack of context provided with the data that could help explain physician prescribing practices and pharmacy filling practices before conclusions are drawn.”