MMS Statement Regarding the Release of Medicare Physician Payment Data

Contact:
Richard P. Gulla, MMS
(781) 434-7101
rgulla@mms.org

Following is a statement from Ronald W. Dunlap, MD, President of the Massachusetts Medical Society, on the release of physician-specific Medicare payment data:

While we agree that more transparency in health care is a good thing, and that the prevention and discovery of fraud and abuse is also important, the Massachusetts Medical Society shares the American Medical Association’s concerns about what people need to consider when evaluating physician information. The AMA has outlined the following concerns about the release of the CMS payment data:

1. The data could contain errors. Physicians don’t have a way to review or correct the information reported.

2. Care quality can’t be assessed from the information reported. The data focuses solely on payment and utilization of services and doesn’t include explicit information about the quality of care provided.

3. The reported number of services could be misleading. For instance, residents and other health care professionals under a physician’s supervision can file claims under his or her National Provider Identifier, and the data may not properly detail who performed the services.

4. Billed charges and payments aren’t the same. CMS will report both the physician’s billed charge and the actual amount paid, which is set by the Medicare Physician Fee Schedule. Payments generally are much less than the billed amount.

5. The data doesn’t represent the physician’s patient population. The data won’t include services related to non-Medicare patients or account for the complexities of the physician’s patient population; it is not risk-adjusted.

6. Payment amounts vary based on where the service was provided. Medicare pays physicians less for services provided in a hospital outpatient department than for services provided in the physician’s office to reflect a difference in the practice costs. But Medicare makes another payment to the facility to cover its practice costs when services are provided in the outpatient department. That means that in reality, the total costs to Medicare and the patient may be higher when a service is provided in a facility setting.

7. The data doesn’t enable clear comparisons of physicians. Specialty descriptions and practice types aren’t very specific, so physicians who appear to have the same specialty could serve very different types of patients and provide a dissimilar mix of services, making some subspecialists appear to be outliers.

8. Important information is missing. The data does not account for patient mix, patient demographics, or drug and supply costs.

9. Coding and billing rules differ over time and across regions. Changes to Medicare’s coding and billing rules need to be taken into account in any analysis because these rules frequently change over time and across different parts of the country.


The Massachusetts Medical Society, with more than 24,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society, under the auspices of NEJM Group, publishes the New England Journal of Medicine, a leading global medical journal and web site, and NEJM Journal Watch alerts and publications covering 13 specialties. The Society is also a leader in continuing medical education for health care professionals throughout Massachusetts, conducting a variety of medical education programs for physicians and health care professionals. Founded in 1781, MMS is the oldest continuously operating medical society in the country.


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