American Speech-Language-Hearing Association

Medicare Releases Provider Payment Data

(May 9, 2014)

The Centers for Medicare & Medicaid Services (CMS) recently released a public data set, the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (Physician and Other Supplier PUF), that provides information on services and procedures provided to Medicare beneficiaries by individual health care professionals—including audiologists and speech-language pathologists (SLPs)—enrolled as Medicare providers. The data is based only on Part B (outpatient), non-institutional services paid under the Medicare Physician Fee Schedule. Providers who saw fewer than 11 Medicare patients in 2012 were not included in the data set.

The data release includes information on calendar year 2012 average charges, the total amount Medicare paid, the number and type of services provided, and the number of unique Medicare patients seen by individual providers. The data is available on the CMS website in Microsoft Excel files that are listed in alphabetical order by last name. Audiologists and SLPs can find their specific data by downloading the appropriate spreadsheet and then searching by National Provider Identifier (NPI) or sorting by last name. For quicker access, providers can also use the Interactive Physician and Other Supplier Dataset or the Medicare Physician and Other Supplier Look-up Tool, which was designed primarily for consumer use.

Many concerns have been raised regarding limitations to the data. For example, it does not indicate the quality of care provided, does not represent the provider's entire patient population, and does not account for differences in underlying severity of the patient population.

Audiologists and SLPs who may be included in the data release should look their information up in order to understand what the public is seeing. It is also important to understand the data limitations, should any misinterpretations of the data need to be addressed. However, audiologists and SLPs need to be aware that there is currently no mechanism for providers to correct the information released in the data set.

ASHA will continue to monitor public reaction to the Medicare data release and supports the efforts of the American Medical Association to educate the media and the public regarding the data.

Background

According to CMS, this data was released in response to requests filed under the Freedom of Information Act and is "part of the Obama Administration's efforts to make our healthcare system more transparent, affordable, and accountable," to allow patients to "make more informed choices about the care they receive," and to "help reduce fraud and waste in the system." The data includes approximately $77 billion in payments to more than 880,000 health care professionals who provided services under the Medicare Physician Fee Schedule (Medicare Part B). Previously, CMS was barred from publishing such data due to a 33-year-old injunction. The injunction was lifted by a federal judge in May 2013.

Resources

CMS has published Frequently Asked Questions regarding the data release on their website. Specific inquiries regarding the data can be sent to CMS at MedicareProviderData@cms.hhs.gov. Questions can also be addressed to ASHA's health care economics and advocacy team at reimbursement@asha.org.


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