The Big Medicare Payment Data Release

Today Medicare released payment data for over 880,000 healthcare providers, and include charge and payment information, provider specialties and addresses, billing codes, and other specific information.  The Medicare data set is downloadable here.  The description on the Medicare web site describes the data set as:

“Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (Physician and Other Supplier PUF), with information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals.  The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS’s National Claims History Standard Analytic Files. The data in the Physician and Other Supplier PUF covers calendar year 2012 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.”

There are some notable caveats to making conclusions about the data, which have been extensively outlined by docgraph.org.  Problems such as payer mix and specialty bias should be considered.  For example, pediatricians will have many fewer Medicare patients, while specialties with patients 65+ or special Medicare programs, such as Nephrology (Disclosure:  this my sub-specialty), may have a higher proportion of Medicare insured patients.

How will this large data set help us understand healthcare practices in the United States?  Several promising analyses come to mind:

  • Analysis of varying payment amounts for similar procedures – Because the same medical procedure can be billed on several different codes that account for the complexity of care provided, there is the opportunity for the “Lake Woebegone Effect” – where all the procedures have above average difficulty.  In some cases it might be true that a particular physician specializes in the most difficult cases (e.g. advanced chemotherapy using an implantable pump for liver cancer), but this is the exception rather than the rule.

 

  • Network analysis of unusual billing patterns -Here is where coupling this database with DocGraph (see my previous post here), a network graph database of all the referral patterns for Medicare for all US patients, may yield very interesting findings.  Some networks of physicians may have unusual billing patterns compared with others.  In some cases, this will be a sign of efficiency and great medical care delivery.  In others, it may be a sign of inefficiency or, in rare cases, something more ominous such as a pattern of fraud among a group or organization of providers.

 

  • Network analysis of procedure frequency – More useful, will be the ability to study types of procedures and visits among providers in different geographic areas, and the reimbursement variations.  Already, USA Today has posted a map of average reimbursement by state.  While some sophisticated analysis will be needed to reach thoughtful conclusions about regional variations in care, this will certainly spur a great deal of analysis and hopefully some good healthcare policy.

 

So, a good day for data transparency in healthcare delivery, and I say that as somebody whose Medicare practice is in the database! Let’s hope that high quality data analytics with thoughtful research follows.