HHS Releases Physician-Level Medicare Data

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
Room 352-G
200 Independence Avenue, SW
Washington, DC 20201
FACT SHEET

FOR IMMEDIATE RELEASE Contact: CMS Media Relations
April 9, 2014 (202) 690-6145(202) 690-6145

HHS Releases Physician-Level Medicare Data

Today the Department of Health and Human Services (HHS) released a new privacy-protected data set that has information on the number and type of health care services that individual physicians and certain other health care providers furnished in 2012 under the Medicare Part B fee-for-service (FFS) program, as well as information on the amount that Medicare paid them for those services. The new data set has information for over 880,000 distinct health care providers in all 50 states, DC and Puerto Rico who collectively received $77 billion in Medicare payments in 2012. The new data are posted on the website of the Centers for Medicare & Medicaid Services (CMS).

CMS created the new data set using information from the Physician/Supplier Part B Claims File, also known as the Carrier File, which has final action FFS claims that are submitted by physicians and other non-institutional health care providers, such as non-physician practitioners, ambulatory surgical centers, clinical laboratories, and ambulance providers. The new data set does not have information for institutional health care providers, such as hospitals or nursing homes, or for suppliers of durable medical equipment; some data on these types of providers is already publicly available: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Tren....

The new data set identifies individual providers using their National Provider Identifier (NPI) and the specific services that they furnished using Healthcare Common Procedure Coding System (HCPCS) codes. For each provider and service, the new data set has the total number of services that were furnished, the provider’s average charge, the average Medicare payment, and the average Medicare-allowed amount, which is the sum of Medicare’s payment and any deductible or coinsurance owed by the beneficiary. The new data set also has the standard deviation for each payment metric, so that users of the data can better understand how much the payment amounts varied, even for a specific service. CMS did not include information in cases where a provider furnished 10 or fewer units of a particular service to ensure the confidentiality of patient-specific information.

When health care providers obtain an NPI, they indicate whether the NPI will be used by an individual or an organization and the specialty that best describes the type of health care services that they furnish. The chart below shows the ten specialties with the highest aggregate Medicare payments in the new data set; together, those provider specialties accounted for 57 percent ($44 billion) of the total Medicare payments included in the new data set...  READ MORE & VIEW GRAPHICS