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WCH Opinion: Patients Now Know How Medicare Pays their Doctor, What’s Next?

Wednesday, July 23, 2014

As part of the Obama Administration’s efforts to make our healthcare system more transparent, affordable, and accountable, the Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data.

The US government made public data about Medicare payments to doctors, providing details such as the procedures doctors performed and how much they were paid and place of service. The date reflects calendar year 2012 for Part B Medicare fee for service providers. The data shows that Medicare made total payments to more than 880,000 medical providers in 2012, totaling $77 billion.
The data provides information on payment and utilization for Medicare Part B services but also has a number of limitations.  Primarily, the data does not reflect physician’s entire practice as it only includes information on Medicare fee-for-service beneficiaries.  Also, this  data are not intended to indicate the quality of care provided and are not risk-adjusted to account for differences in underlying severity of disease of patient populations. 

Aside from adding transparency, the exposure of the Medicare reimbursement for providers has not added any value to the providers. The data is now available to the public to view the reimbursement Medicare providers receive but there is no benefit to the providers from this information.  People often jump to conclusions thinking that if the provider received large reimbursement means the providers did something wrong. People often make that assumption without looking at the large picture and taking into account other details which are not available to the public. Seeing a large number paid out to the provider doesn’t always mean fraud is involved. Although the data is detailed and provides a lot of information, it does not and cannot reflect the physician’s entire practice.



Share your opinions with us regarding releasing Medicare payment information with with our readers the public by emailing us at ilanak@wchsb.com 


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