CMS PUBLISHES PROVIDER CHARGE & PAYMENT DATA

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  • April 9, 2014

4/9/2014
On Wednesday, April 8, the Centers for Medicare and Medicaid Services (CMS), published files detailing 2012 Medicare Part B payments to individual providers and physician practices. The files include what the provider charged as well as Medicare payments by procedure code.

The files, which are on the CMS website, provide charge and payment data which CMS states they released in response to demands for transparency. Of concern, is the fact that the data was released without explanation of the Medicare payment system or what the data really shows. This is particularly troublesome for oncology as high cost chemotherapy drugs are shown as having a high revenue rate without mention of the cost of the drugs. In addition, the data is misleading as some revenue that is reported for one provider may be dispersed to other group providers or practices.

Since publication of the data, news articles in national publications began reporting that specialists in hematology/oncology were second only to ophthalmologists in receipts of Medicare payments. In response to news articles and the concern that the data was misleading, the American Society of Clinical Oncology (ASCO), the American Society of Hematology (ASH), the American Society of Radiation Oncology (ASTRO), and the Association of Community Cancer Centers (ACCC) have all condemned the release of the figures without any context, saying this will lead to misinterpretations.

In a press release, ASCO states, “Most of the amounts shown in the Medicare database for oncologists are not, in fact, revenue to oncology practices. Instead, these Medicare payments merely cover the upfront costs of purchasing drugs for patients. Also, the data reflect the high cost of some chemotherapy drugs which further distort the actual practice revenue.” Finally, ASCO reports extensive inaccuracies and errors in the data for many oncologists are being reported.

The files do not include information on payments made by private insurers, uninsured patients, Medicaid, or Medicare Advantage plans.

All providers including physicians, NPs, PAs and other Medicare providers are urged to review their CMS reported data. The Medicare Provider Charge Data is available at:

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

ASCO Statement:
http://www.asco.org/asco-alarmed-about-medicare-payment-data-release

New York Times article:
http://www.nytimes.com/interactive/2014/04/09/health/medicare-doctor-database.html

Wall Street Journal article:
http://online.wsj.com/news/articles/SB10001424052702303873604579492012568434456?mg=reno64-wsj