On Monday, CMS publicly released new online data that reveal hospitals’ Medicare charges and payments, as well as what doctors billed, in 2013, Modern Healthcare reports (Herman, Modern Healthcare, 6/1).
The data were unveiled at the Health Datapalooza conference in Washington, D.C. (CMS release, 6/1). It is the third straight year that Medicare has posted hospital charge and payment data and the second straight year it has posted physician payment data (Sanger-Katz/Thomas, New York Times, 6/1).
The three data sets released by CMS encompass more than 3,000 hospitals 950,000 physicians, nurse practitioners and other providers, and more than $150 billion in total payments (Modern Healthcare, 6/1). The data only include Medicare payments for traditional program beneficiaries and not those enrolled in Medicare Advantage plans (New York Times, 6/1).
The breadth of the new data continues CMS’ commitment to transparency, officials said (CMS release, 6/1). Acting CMS Administrator Andy Slavitt said, “These data releases will give patients, researchers and providers continued access to information to transform the health care delivery system. It’s important for consumers, their providers, researchers and other stakeholders to understand the delivery of care and spending under the Medicare program” (Walsh, Clinical Innovation & Technology, 6/1).
Hospital Data Details
The Medicare hospital utilization and payment data include information related to the 100 most common Medicare inpatient stays, which represent approximately $62 billion in Medicare payments and more than seven million hospital discharges. The hospital data set also includes information on 30 selected outpatient procedures (Modern Healthcare, 6/1).
CMS said that hospital charges have increased at a “modest rate.” For example, major joint replacement charges — the most frequent discharge in the nation in 2013, with 446,148 total discharges — have grown an average of $50,116 in 2011 to $54,239 in 2013 (CMS fact sheet, 6/1). Medicare on average paid about $12,000 per case of joint replacement.
Hospital list prices predominantly affect uninsured individuals and those with insurance who receive care at out-of-network facilities.
Meanwhile, the data show that hospital charges for some common procedures increased by upwards of 10% between 2011 and 2013, more than twice the rate of inflation, according to the New York Times.
However, Medicare payments to hospitals have mostly stayed flat, the Times reports (New York Times, 6/1).
Physician Data Details
Meanwhile, the new Medicare Part B data include payments to more than 950,000 distinct providers who collectively received $90 billion (CMS release, 6/1).
The data show that physicians on average were reimbursed $74,000 by Medicare in 2013,Bloomberg reports. However, at least 3,900 individual physicians were paid at least $1 million, while five doctors were paid more than $10 million (Tracer/Chen, Bloomberg, 6/1).
Overall, the top 1% of Medicare billers in 2013 received 17.5% of the payments made by the program to individual providers that year, according to the Wall Street Journal. By comparison, the top 1% of billers received 16.6% of Medicare payments to individual providers the year before, theJournal reports.
According to the Journal, some of the top billers were major prescribers of high-cost drugs, while others acquired medical equipment that allowed them to bill Medicare for services they otherwise might have referred to hospitals. Overall, about 70% of the approximately $9 billion in Medicare payments to individual providers to administer medications in 2013 went to the top 1% of Medicare billers.
The top three 2013 billers were:
- Anne Greist runs the only hemophilia center in Indiana and received $28 million from Medicare, nearly all for high-cost treatments for a limited number of patients with hemophilia (Waver et al.,Wall Street Journal, 6/1);
- Asad Qamar, who received $16 million and is being sued by the federal government based on allegations that he performed unnecessary surgical procedures; and
- Salomon Melgen, a Florida-based ophthalmologist connected to corruption charges brought against Sen. Robert Menendez (D-N.J.), who has been indicted for health care fraud (New York Times, 6/1).
American Medical Association President Robert Wah said his organization is concerned that the 2013 data have “significant shortcomings,” such as a lack of:
- “Actionable information on the quality of care”; and
- Appropriate “context to prevent … inaccuracies, misinterpretations and false assertions.”
Wah said, “We continue to urge CMS to improve upon its data releases so that patients and physicians can actually use the information to better work together to improve quality, improve health outcomes and reduce costs” (AMA release, 6/1).