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Medicare Opens Up Payment Data - Health Care Edge

Medicare Opens Up Payment Data

By Sam Baker, Sophie Novack and Clara Ritger


ENORMOUS DATA TROVE RELEASED: For the first time, Medicare is releasing detailed records about how much it pays individual doctors. The information is public -- you can download the (massive) database here to find out how much your doctor (or friend or neighbor who happens to be a doctor) received from the Medicare program, and for which services.

The intended audience, though, is mostly academics and researchers, who will be able to comb through the data in search of trends or on the hunt for possible waste and abuse. The American Medical Association fought the release for years, saying the data threatened doctors' privacy and could be inaccurate, but CMS ultimately decided that the public interest in seeing detailed payment data outweighed physicians' concerns.

Top Health Care News

MEDICARE PAYMENTS: Two percent of the 880,000 Medicare physicians made up almost one-quarter of the $77 billion in spending on the program in 2012. (Reed Abelson and Sarah Cohen, New York Times)


SURVEY SHOWS EMPLOYER COVERAGE SURGING: A new Rand Corp. survey estimates that 9.3 million people were newly insured between Sept. 2013 and March 2014, with most of the increase coming from employer-sponsored health plans. (Jason Millman, Washington Post)

STUDY OFFERS LOOK AT HEALTH STATUS OF EARLY OBAMACARE ENROLLEES: According to a study released today by Express Scripts, the major pharmacy-benefits manager, people who signed up early for insurance through the new exchanges were more likely to be prescribed medication to treat pain, depression, and H.I.V., and less likely to need contraceptives. The study indicates that early enrollees are older and face more serious health issues than those with employer-sponsored coverage, and that they have a higher use of specialty drugs, which could suggest more expensive medical problems. (Katie Thomas, New York Times)

More on Medicare Payments

  • Nearly 4,000 Medicare providers made more than $1 million each, including seven who were paid more than $10 million in 2012. The highest -- a Florida opthamologist -- was paid $21 million by Medicare. The average paid by the program was $77,000. (Shannon Pettypiece and Alex Wayne, Bloomberg News)

  • The American Medical Association has fought the release of the payment data but declined to go to court to block the administration from releasing the information. (Jonathan Easley, The Hill)

  • AMA President Ardis Dee Hoven, M.D., released the following statement: "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. Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences. Thoughtful observers concluded long ago that payments or costs were not the only metric to evaluate medical care. Quality, value and outcomes are critical yardsticks for patients."

  • The release gives consumers new tools to choose doctors, but it's important to know how to use the information. On that note, a warning to use caution when approaching the huge data set. (Charles Ornstein, ProPublica)

  • The New York Times and the Wall Street Journal have interactive tools to search the database for specific doctors.

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HOW VERMONT IS TRYING TO BRING A SINGLE-PAYER SYSTEM TO THE U.S.: "The state is three years deep in the process of building a government-owned and -operated health insurance plan that, if it gets off the ground, will cover Vermont's 620,000 residents — and maybe, eventually, all 300 million Americans." (Sarah Kliff, Vox Media)

NEVADA OFFERS RARE BET: YEAR-ROUND SALES OF HEALTH PLANS: There could be an incentive to get signed up for coverage before getting sick though, because the Nevada law that took effect in January allows insurance companies to delay the start of the new coverage for up to 90 days. (Michelle Andrews, Kaiser Health News)

WAVE OF NEWLY INSURED PATIENTS STRAINS OREGON HEALTH PLAN: Some doctors are getting paid bonuses for accepting new patients. (Kristian Foden-Vencil, NPR News)


HOUSE LIKELY TO PASS BIPARTISAN OBAMACARE ADJUSTMENT: The Expatriate Health Coverage Clarification Act would create an exemption under the health law for individuals working outside their home country. The bill was introduced by Democratic Rep. John Carney this week, and an aide to the Congressman said the House is likely to consider it under a suspension of the rules today. (Pete Kasperowicz, The Hill)


TEEN BIRTH RATE DROPS, BUT CONCERNS REMAIN: A Centers for Disease Control report issued Tuesday found that births to girls ages 15 to 19 have declined from 84.1 per 1,000 teens in 1991 to 29.4 in 2012. However, over one-fourth of those children--or almost 1,7000 per week -- were born to younger teens ages 15 to 27. (Lenny Bernstein, Washington Post)

NO PRIMARY CARE SHORTAGE FOR THE INSURED: A study published in JAMA Internal Medicine this week found that researchers posing as nonelderly adult patients were able to make an appointment with a primary care physician on the first try about 85 percent of the time when they said they had private insurance. Those saying they had Medicaid got appointments about 60 percent of the time from providers listed as accepting Medicaid; those who said did not have insurance were four times less likely to get an appointment than those claiming Medicaid coverage. (Elana Gordon, WHYY/Kaiser Health News)

JAILS AND PRISONS HOUSE TEN TIMES MORE PATIENTS WITH MENTAL ILLNESS THAN STATE HOSPITALS: Jails and prisons hold 356,268 inmates with severe mental illness, according to a report published by the Treatment Advocacy Center. In 44 states, the largest jail or prison holds more people with serious mental illness than the largest psychiatric hospital. (Sarah Kliff, Vox Media)


HOW THE U.S. HEALTH CARE SYSTEM IS BECOMING LIKE GERMANY'S (AND WHAT THE U.S. CAN DO EVEN BETTER): "[A few] differences aside, it's fair to say the U.S. is moving in the direction of systems like Germany's—multi-payer, compulsory, employer-based, highly regulated, and fee-for-service. You can think of this setup as the Goldilocks option among all of the possible ways governments can insure health. It's not as radical as single-payer models like the U.K.'s, where the government covers everyone. And it's also not as brutal as the less-regulated version of the insurance market we had before the ACA." (Olga Khazan, The Atlantic)

Testing and Treatment

AS DNA TESTING BECOMES MORE UBIQUITOUS, CONSUMERS FEAR PUNISHMENT FOR DANGEROUS MUTATIONS: "The Genetic Information Nondiscrimination Act, known as GINA, does not apply to three types of insurance — life, disability and long-term care — that are especially important to people who may have serious inherited diseases...That leaves many patients who may be at risk for inherited diseases fearful that a positive result could be used against them."

PHARMACY BENEFITS MANAGER CRITICIZES HIGH PRICE OF HEPATITIS C TREATMENT: "'Never before has a drug been priced this high to treat a patient population this large, and the resulting costs will be unsustainable for our country,' warns Express Scripts chief medical officer Steve Miller, in a statement...Thanks to Sovaldi and the high bar it may have set on pricing for subsequent drugs, the latest Express Script forecast suggests that overall spending on hepatitis C medications will rise 102% this year and nearly 209 % next year. By comparison, spending on cancer treatments, which rose 24.1% last year, is predicted to rise 24.4% this year and another 24.7% next year." (Ed Silverman, Wall Street Journal)

Happening Today

SENATE HEARING ON DEFENSE HEALTH PROGRAMS: The Senate Appropriations Defense subcommittee will hear testimony from the Surgeon General of the United States Army, Surgeon General of the United States Navy, Surgeon General of the United States Air Force, and program executive officer for the Defense Healthcare Management System, at 10 a.m.

HOUSE HEARING ON VETERAN'S CARE: The House Veteran's Affairs Committee will hold a full committee hearing on "A Continued Assessment of Delays in VA Medical Care and Preventable Veteran Deaths" at 10 a.m.

BRIEFING ON PRESCRIPTION DRUG ABUSE: Reps. Joe Pitts and Frank Pallone, Jr. will host a Congressional briefing in partnership with the Alliance to Prevent the Abuse of Medicines To discuss prescription drug abuse, chronic pain treatment, and the importance of access to legitimate medications from 4:00 p.m. to 5:30 p.m. in Rayburn 2322.


Don't Miss Today's Top Stories

Health Care Edge is one of my top resources."

Meghan, Associate Specialist

Great news in short form along with much needed humor."

Patrick, President of private healthcare consulting firm

Informative and help[s] me stay on track. "

Director of Scientific Affairs, Non-profit medicial society

Sign up form for the newsletter
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