The Physician Payment Public Use File data can be misleading because the amount received by a single physician may represent payment for the services of numerous providers or because it may cover reimbursement for medications delivered together with the physicians' professional services, according to an Anesthesia Business Consultants blog post.
The Provider Utilization and Payment Data Physician and Other Supplier Public Use File, recently released by CMS, includes information regarding the approximately $77 billion that Medicare Part B paid out to over 880,000 health care providers in 2012.
However, the data has several limitations including:
1. The data may not be representative of a physician's entire practice, since it only pertains to Medicare beneficiaries with fee-for-service coverage.
2. Services provided to fewer than 11 patients are excluded because of privacy concerns, and so summing up the data may underestimate the true totals.
3. The data does not indicate the quality of care provided and is not adjusted for severity of illness.
4. Medicare payments for a given procedure vary based on a number of factors, including geographic cost of practice adjustments as well as multiple services provided to the same beneficiary on the same day.
5. The exclusion of facility fees paid separately to hospitals and to ambulatory surgery centers may make services provided in those facilities appear less expensive than those provided in physicians' offices.
6. Services provided by residents, nurse practitioners, physician assistants and other physicians may be attributed to an individual provider whose National Provider Number is used.
7. There has been no opportunity to correct inaccurate data.
8. As the Medical Group Management Association observed, "Revenue does not equal profit."
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The Provider Utilization and Payment Data Physician and Other Supplier Public Use File, recently released by CMS, includes information regarding the approximately $77 billion that Medicare Part B paid out to over 880,000 health care providers in 2012.
However, the data has several limitations including:
1. The data may not be representative of a physician's entire practice, since it only pertains to Medicare beneficiaries with fee-for-service coverage.
2. Services provided to fewer than 11 patients are excluded because of privacy concerns, and so summing up the data may underestimate the true totals.
3. The data does not indicate the quality of care provided and is not adjusted for severity of illness.
4. Medicare payments for a given procedure vary based on a number of factors, including geographic cost of practice adjustments as well as multiple services provided to the same beneficiary on the same day.
5. The exclusion of facility fees paid separately to hospitals and to ambulatory surgery centers may make services provided in those facilities appear less expensive than those provided in physicians' offices.
6. Services provided by residents, nurse practitioners, physician assistants and other physicians may be attributed to an individual provider whose National Provider Number is used.
7. There has been no opportunity to correct inaccurate data.
8. As the Medical Group Management Association observed, "Revenue does not equal profit."
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