Release of Medicare Data Sparks Controversy

April 9, 2014

It’s too soon to tell what effect the release of Medicare data will have on the radiology community.

Centers for Medicare and Medicaid Services (CMS) released today a public data set with information on payment of services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals.

The information was released as part of the Obama Administration’s efforts to make the U.S. healthcare system more transparent, affordable and accountable. The release of information, however, has caused a media frenzy and sparked some controversy.

News organizations have already aggregated the data and released information about the providers receiving the highest reimbursements. The American Medical Association (AMA), however, cautions against taking this information at face value.

“The AMA is committed to transparency and the availability of information for patients to make informed decisions about their medical care,” Ardis Dee Hoven, MD, president of the AMA, said in a release. “We believe that the broad data dump today by CMS has significant short-comings regarding the accuracy and value of the medical services rendered by physicians.”

The data were released after a court order lifted an injunction that prohibited the public release of the information. The injunction was originally sought by the AMA and had been in place since 1979. The AMA, who decided not to go to court to block the scheduled release, is concerned that releasing the data without context will lead to inaccuracies, misinterpretations and other unintended consequences. CMS released the data without preverification by physicians, so some of the data may contain errors. In addition, the data does not report on quality of care or quality measurement, it solely focuses on the payment and utilization of services.

“The information released by CMS will not allow patients or payers to draw meaningful conclusions about the value or quality of care,” Dee Hoven said in a release.

While the information may be nonspecific and flawed, it still raises the question of how this will affect the healthcare system, and if/how patients will use the data. The report, which contains hundreds of thousands of rows of data, is divided into two spreadsheets, one spreadsheet reports the summary data: provider name and address, total number of Healthcare Common Procedure Coding System (HCPCS) codes, total number of Medicare beneficiaries receiving the provider services, total number of provider services, total charges that the provider submitted for all services, total Medicare allowed amount for all provider services (sum of the amount Medicare pays, including the deductible and coinsurance amounts that the beneficiary and any third party is responsible for paying) and the amount that Medicare paid to the provider after the deductible and coinsurance amounts for deducted for the line item service.

The other spreadsheet breaks down the payments by service and, among other items, compiles HCPCS code, the description of the HCPCS code, the location type of the service (“facility” or “non-facility”, where non-facility is generally an office setting), average Medicare allowed amount for the service, average of the charges the providers submitted for the service, and the average amount Medicare paid after the deductible and coinsurance amounts have been deducted for the line item service.

The radiology community hasn’t yet determined the effects of the data release. But the AMA is resolute: “The AMA is disappointed that CMS did not include reasonable safeguards that would help the public understand the limitations of this data,” Dee Hoven said in the release.