Medicare physician data to be released annually: What does it mean for researchers and consumers?

According to the Wall Street Journal, the Centers for Medicare and Medicaid (CMS) will begin publish Medicare physician payment data annually. CMS released a year’s worth of data from 2012 in April 2014, and has since earned significant criticism across stakeholder groups, particularly physician groups, who claim that the information is flawed and lacks context.

These critics are not entirely mistaken. It is clear that the dataset has several limitations.

For example, because the data is not adjusted to account for providers who have a disproportionately sicker, more expensive patient population, the data may unfairly depict them as high spenders. Some physicians may have also appeared to receive excessive amounts of Medicare payments because other health care providers were billing under his/her provider identification code – a system that is erroneous, yet common in group practices. Ultimately, analysts could not use this dataset alone to answer important questions such as: does the cost of care for the same service vary between geographical areas? Which clinicians are providing unnecessary services? Do the doctors that spend more provide better care?

Instead, analysts mainly used this dataset to pick out those physicians with truly high or unusual Medicare spending patterns. Though, according to a ProPublica study, in most cases, these providers had already been flagged and disciplined for their questionable billing practices.  So why continue releasing this data?

Why is the CMS decision an important one?

CMS officials defended the admittedly imperfect release by arguing that it was one step toward achieving the much larger goal of creating a more open or ‘transparent’ health care system. Currently, the U.S. health care system is suffering from a lack of publically available, easily accessible information. It is considerably more difficult than it should be for a patient to selectively choose providers based on the cost and quality of the care they provide for a specific service or procedure; for a doctor to know which providers are best to refer their patients to for specific conditions; and for insurers to decide which providers to include in their high value networks.

However, these decisions are critical during a time in which national health care spending makes up a large share (17.4 percent) of the US economy, and the health care costs that individuals are expected to pay out of their own pockets before insurance kicks in, is increasing. Policy makers and researchers argue that empowering the public with more and better health care information will ultimately help spur the provision of higher quality care at a lower cost.

CMS’s decision to release more data every year is therefore a move in the right direction. Hopefully, the first Medicare physician payment data release in 2014 served as a starting point and the future data that CMS is planning to publish will learn from its limitations. At the very least, releasing this data across time will allow for researchers to identify trends among high spending physicians, and hopefully uncover why such patterns exist.

Remaining Challenges

Though getting data in the public domain is important, it is also critical that transparency initiatives begin to focus on how to render the published information more useful for various stakeholders to compare and choose providers.

The Engelberg Center for Health Care Reform recently published a policy brief that outlines the regulatory changes necessary to make health care data more meaningful and accessible to consumers and addresses their common health care needs.

Until these barriers are overcome, transparency efforts will continue to fall on a largely disengaged audience and will fail to stimulate the overall improvement of our health care system.