How hospitals, insurers are using the new doctor pay data

Data analyses could inform M&A activity, improve patient care

Hospitals, insurers, and other health care industry groups are examining the newly released Medicare physician payment data for insights that may help inform important business decisions, Modern Healthcare's Joe Carlson reports.

Medicare reveals how much it pays each doctor. Here's what the data show

CMS published the payment data last week for the first time since 1979, showing how the program paid out $77 billion to more than 880,000 health care providers in 2012. Specifically, the data included:

  • Physicians' names and addresses;
  • Summaries of the services provided; and
  • The amount providers were paid for the services.

The data did not include any patient information.

The agency plans to release data on Part B payments each year in an effort to "provide a better picture of how physicians practice in the Medicare program," CMS's Jonathan Blum said in a statement.

Hospitals, insurers look to capitalize on new data

Graham Hughes, CMO of business-analytics firm SAS, says the business insights that may be gleaned from the new data are "near limitless," adding, "The focus will be on utilization, practice patterns, and practice variation. I have heard directly from some of our (hospital) customers that they are poring over this data as we speak."

How 10 doctors netted $121M in Medicare dollars

For example, hospitals may use the new information to gain a better understanding of individual doctors' practice patterns and their patient bases, which may inform decisions on whether to partner or acquire practices. The data may also reveal which providers are treating the most patients within a particular ZIP code and for what diagnoses—insights that are necessary as hospitals and physicians partner on accountable care efforts and other care delivery networks.

Meanwhile, insurers and self-employed insurers also stand to benefit from the Medicare data set, which is far larger than what they could have accessed previously. Data on which doctors order the most costly services, procedures, and drugs will be beneficial to companies selecting which "preferred providers" to include in their shift to narrower, value-based networks.

Researchers, consumers may benefit, too

The data also may help consumers select new doctors, says Robert Krughoff, president of Consumer's Checkbook, a patient advocacy group that sued for the release of Part B data in 2006. The data shed light on which physicians have the most background performing complex procedures. "There is quite a bit of evidence that says experience matters in many types of procedures," he says.

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Researchers also will comb through the numbers for evidence of practice pattern variation by location. Experts say that doing so will not only reduce fraud and waste, but also protect patients from injuries and infections that result from unnecessary services and procedures.

"There is an enormous amount of entirely legal but inappropriate patterns of care that are provided under Medicare," says Bill Kramer, executive director of U.S. health policy at the Pacific Business Group on Health. The Part B claims, especially when combined with data from all-claims databases, will reveal "who the best doctors and hospitals are," Kramer predicts, adding, "It is ultimately how we are going to improve the whole health care system" (Carlson, Modern Healthcare, 4/12 [subscription required]).


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