CMS Releases Annual Physician Payment Data

by | Last updated May 17, 2023 | Published on Nov 4, 2015 | Healthcare News

Physician Payment
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The Centers for Medicare and Medicaid Services (CMS) recently released fee-for-service payment data for individual physicians in an effort to make the opaque US Healthcare system more accountable.

CMS is distinguishing between payments for medical services such as an office visit and payments for administered Part B drugs. This sudden breakout comes after oncologists complained that the “2012 Medicare payment totals” (released last year) mostly represented reimbursement for drugs that they had to purchase, which was not actual revenue.

Data about hospital inpatient and outpatient charges was first released in the year 2013. The new sets of data released by the CMS (on June 1, 2015) provides details regarding money in payments from medical billing by hospitals for both inpatient and outpatient services and Medicare payment for physicians in 2013.

The latest data published by the CMS includes $90 billion in Medicare fee-for-service payments to some 950,000 physicians, nurse practitioners, physician assistants, nurse anesthetists and other clinicians in 2013. This list includes types and number of services performed, the average Medicare payment and the average Medicare-allowed amount (which combines the Medicare payment and any deductible or co-insurance owned by the patient).

In addition, the CMS data shows payments to hospitals for 100 of the most common inpatient stays and the 30 most common outpatient procedures performed at more than 3000 hospitals in 2013. The inpatient stays covered more than 7 million discharges and generated $62 billion in Medicare payments. The current data signifies that spending on hospitals and physician services makes up a majority of the US healthcare expenses.

According to Niall Brennan, CMS’ chief data officer, “the agency will continue to release hospital and physician data annually.” CMS has now released data from 2011, 2012 and 2014. The charges for various inpatient and outpatient procedures showed wide fluctuations, particularly among hospitals in the same region.

Hospitals have long been under intense scrutiny for their medical billing practices, often triggered by high charges or sticker prices even for the most common procedures. Patient advocates argue that hospital pricing is covered in secrecy, which leaves patients on the hook for costly medical bills. Therefore, these data releases will give patients and providers continued access to healthcare information which in turn may transform the healthcare delivery system. However, hospitals argue that the listed charges are irrelevant as they serve as a starting point for negotiations with insurers and that patients rarely, if ever, pay those prices.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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