Interactive Tool Allows Easier Access Data on Physicians

Author: Niall Brennan, Acting Director, Offices of Enterprise Management

Today, the Centers for Medicare & Medicaid Services (CMS) released a new interactive search tool that can help consumers and other stakeholders navigate information about the types of medical services and procedures delivered by physicians and other healthcare professionals. Users can search for a provider by name, address, or National Provider Identifier (NPI). Once a user selects a provider, the tool returns information about the services the provider furnished to Medicare beneficiaries, including the number of services provided, the number of beneficiaries treated, and the average payment and charges for such services.

This new look-up tool makes it easier to use the large data set about physician information that CMS released on April 9, 2014 to look up specific providers. As with the data set, the look-up tool does not include information for cases where a provider administered a particular service 10 or fewer times to ensure the confidentiality of patients’ personal information. In addition, the information in the look-up tool only reflects the services provided to Medicare fee-for-service beneficiaries and does not include measurements of the quality of care provided by a provider.

The release of this data set provides unprecedented access to information on the types of services physicians and other healthcare professionals deliver under the Medicare program. Within the first week of posting the data, more than 150,000 users downloaded the data, and the CMS website where the data is posted had nearly 250,000 page views.

This is the next step in our effort to provide useful, privacy-protected data to improve transparency as well as the quality and affordability of health care in this country.

Historic release of data delivers unprecedented transparency on the medical services physicians provide and how much they are paid

By Jonathan Blum, Principal Deputy Administrator, Centers for Medicare & Medicaid Services

Today the Centers for Medicare & Medicaid Services (CMS) took a major step forward in making Medicare data more transparent and accessible, while maintaining the privacy of beneficiaries, by announcing the release of new data on medical services and procedures furnished to Medicare fee-for-service beneficiaries by physicians and other healthcare professionals (http://www.cms.gov/newsroom/newsroom-center.html). For too long, the only information on physicians readily available to consumers was physician name, address and phone number. This data will, for the first time, provide a better picture of how physicians practice in the Medicare program.

This new data set includes over nine million rows of data on more than 880,000 physicians and other healthcare professionals in all 50 states, DC and Puerto Rico providing care to Medicare beneficiaries in 2012. The data set presents key information on the provision of services by physicians and how much they are paid for those services, and is organized by provider (National Provider Identifier or NPI), type of service (Healthcare Common Procedure Coding System, or HCPCS) code, and whether the service was performed in a facility or office setting. This public data set includes the number of services, average submitted charges, average allowed amount, average Medicare payment, and a count of unique beneficiaries treated. CMS takes beneficiary privacy very seriously and we will protect patient-identifiable information by redacting any data in cases where it includes fewer than 11 beneficiaries.

Previously, CMS could not release this information due to a permanent injunction issued by a court in 1979. However, in May 2013, the court vacated this injunction, causing a series of events that has led CMS to be able to make this information available for the first time.

Data to Fuel Research and Innovation

In addition to the public data release, CMS is making slight modifications to the process to request CMS data for research purposes. This will allow researchers to conduct important research at the physician level. As with the public release of information described above, CMS will continue to prohibit the release of patient-identifiable information. For more information about CMS’s disclosures to researchers, please contact the Research Data Assistance Center (ResDAC) at http://www.resdac.org/.

Unprecedented Data Access

This data release follows other CMS efforts to make more data available to the public. Since 2010, the agency has released an unprecedented amount of aggregated data in machine-readable form, with much of it available at http://www.healthdata.gov. These data range from previously unpublished statistics on Medicare spending, utilization, and quality at the state, hospital referral region, and county level, to detailed information on the quality performance of hospitals, nursing homes, and other providers.

In May 2013, CMS released information on the average charges for the 100 most common inpatient services at more than 3,000 hospitals nationwide http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html.

In June 2013, CMS released average charges for 30 selected outpatient procedures http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Outpatient.html.

We will continue to work toward harnessing the power of data to promote quality and value, and improve the health of our seniors and persons with disabilities.

Next steps in Medicare data transparency

By Jonathan Blum, Principal Deputy Administrator, Centers for Medicare & Medicaid Services

In letters to the American Medical Association and Florida Medical Association http://downloads.cms.gov/files/Madara_Final_Signed.pdf, the Centers for Medicare & Medicaid Services (CMS) announced our intent today to take another major step forward in making our health care system more transparent and accountable. We plan to provide the public unprecedented access to information about the number and type of health care services that individual physicians and certain other health care professionals delivered in 2012, and the amount Medicare paid them for those services, beginning not earlier than April 9. Providing consumers with this information will help them make more informed choices about the care they receive.

The new data provides a better picture of how physicians practice in the Medicare program, and the payments they receive. This data contains information on more than 880,000 health care professionals in all 50 states who collectively received $77 billion in payments in 2012 for services delivered to beneficiaries under the Medicare Part B Fee-For-Service program. With this data, it will be possible to conduct a wide range of analyses that compare 6,000 different types of services and procedures provided, as well as payments received by individual health care providers.

CMS takes beneficiary privacy very seriously, and does not publicly release any personally-identifiable information about beneficiaries. To further protect beneficiary identities and safeguard this information in this new data, CMS will redact all data in cases where it includes fewer than 11 beneficiaries.

Data like these can shine a light on how care is delivered in the Medicare program. They can help consumers compare the services provided and payments received by individual health care providers. Businesses and consumers alike can use these data to drive decision-making and reward quality, cost-effective care. We look forward to describing how this information can inform consumers and health care providers when we release this data in the near future.

The new data initiative builds on the work we did last year to release information on charges submitted to Medicare by individual hospitals (http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html   and http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Outpatient.html).

The initiative announced today, as well as the previously released hospital data, build on the powerful tools we have from the Affordable Care Act to advance transparency in the health care system. For example, Medicare is beginning to pay providers based on the quality they deliver rather than just the quantity of services they furnish by implementing new programs such as value-based purchasing and readmissions reductions. In addition, last year, CMS made approximately $87 million available to states to enhance their rate review programs and further health care pricing transparency.

While we have made significant progress in making the health care system more open and accountable, we look forward to making this important, new information available so that consumers, Medicare and other payers can get the best value for their health care dollar.

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