New Medicare Data Increases Transparency on Hospital and Physician Utilization

WASHINGTON, DC (June 1, 2015)—As part of the Administration’s efforts to promote better care, smarter spending and healthier people, CMS is posting the third-annual release of the Medicare hospital utilization and payment data (both inpatient and outpatient) and the second-annual release of the physician and other supplier utilization and payment data. The announcement was made at the annual Health Datapalooza Conference in Washington, DC.

“These data releases will give patients, researchers and providers continued access to information to transform the health care delivery system,” said acting CMS administrator Andy Slavitt. “It’s important for consumers, their providers, researchers and other stakeholders to understand the delivery of care and spending under the Medicare program.”

The Medicare hospital utilization and payment data consists of information for 2013 about the average amount a hospital bills for services that may be provided in an inpatient stay or outpatient visit. The hospital data includes payment and utilization information for services that may be provided in connection with the 100 most common Medicare inpatient stays and 30 selected outpatient procedures at more than 3,000 hospitals in all 50 states and the District of Columbia. The top 100 inpatient stays represented in the hospital inpatient data are associated with approximately $62 billion in Medicare payments and more than 7 million hospital discharges.

The Medicare Part B physician, practitioner and other supplier utilization and payment data consists of information on services and procedures provided to Medicare beneficiaries by physicians and other health care professionals. The data also shows payment and submitted charges, or bills, for those services and procedures by provider. It allows for comparisons by physician, specialty, location, types of medical services and procedures delivered, Medicare payment and submitted charges.

The new 2013 dataset has information for more than 950,000 distinct health care providers who collectively received $90 billion in Medicare payments. Hospitals, physicians and other health care providers determine what they will charge for services and procedures provided to patients, and these “charges” are the amount the hospital or provider generally bills for the service or procedure, but the amount paid is determined by Medicare’s physician fee schedule or other payment methodologies. CMS protects beneficiaries’ personal information in all its data releases.

“Data transparency facilitates a vibrant health data ecosystem, promotes innovation and leads to better informed and more engaged health care consumers,” said Niall Brennan, CMS chief data officer and director of the Office of Enterprise and Data Analytics. “CMS will continue to release the hospital and physician data on an annual basis so we can enable smarter decision making about care that is delivered in the health care system.”

The Administration has set measurable goals and a timeline to move Medicare toward paying providers based on the quality, rather than the quantity, of care they give patients. These data releases are part of a wide set of initiatives to achieve better care, smarter spending and healthier people through our health care system. Open sharing of data securely, timely and more broadly supports insight and innovation in health care delivery. Today’s data release adds to the unprecedented information recently released on Medicare Part D prescription drugs prescribed by physicians and other health care providers.

To view a fact sheet on the 2013 hospital charge data, click here. To view a fact sheet on the 2013 Medicare Part B physician data, click here.