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What you can learn about health care costs from a data-dump of Medicare info




Two people walk inside a Medicare Services office.
Two people walk inside a Medicare Services office.
Spencer Platt/Getty Images

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For the first time in more than three decades, Medicare has publicly released information about payments to doctors and other health providers nationwide. 

It's a historic release of data from the federal government. The Obama Administration said it decided last week to make the information public.

It's part of an effort to make our health care system more transparent, affordable and accountable, as well as to inform the national debate about health care spending. 

KPCC's Health Care Correspondent Stephanie O'Neill breaks down what's in it for you.

What does this data include?

Well first it’s gigantic. It lists the services provided by more than 850,000 doctors and other health care providers nationwide who treated about 33 million seniors under Medicare Part B. So we’re talking $77 billion in payments for charges submitted for almost  6,000 different services and procedures.

And it does not contain any patient identification or information on doctors who treated fewer than a dozen Medicare patients.  But there is so much information that it will likely take weeks or months to report out.

What are some of the findings so far?

The Wall Street Journal got a jump on the data, and what their data crunchers have found is that a small set of doctors received a large chunk of that $77 million in payments.  And then they broke it down by specialty and found that it was weighted heavily with ophthalmologists and radiation oncologists

The data set also has some significant limitations, too...

One big limitation is it provides nothing on the quality of care provided, and the data are not risk-adjusted…which means there’s no way to account for differences in the severity of a particular patients disease or, more broadly, of how sick a patient population is in a certain area –which both affect the cost of care. It also doesn’t provide a picture of a doctors full patient load beyond the seniors who are served by Medicare part B.

Tell us about the opposition to the release of this information by the American Medical Association.

The AMA is worried that the information may be taken out of context by the public and potentially damage the reputation of otherwise reputable doctors who follow all the rules and are doing everything right. So in addition to the higher charges that a doctor may charge due to sicker patient populations, the AMA is also concerned that the public may not realize that payments vary widely depending upon which part of the country a doctor practices; some doctors might have much higher billings simply because they see a greater number of Medicare patients than other doctors. 

Meanwhile consumer advocates have a different take on what story this data tells.

They see this as a key way to help the public – researchers, journalists and consumers --  finally get a picture of which doctors over-treat patients, who performs the most surgeries, and what their charges are. That may ultimately help consumers make better-informed choices and will also help provide some of the payment data that quality-reporting websites have long wanted to include in their rankings.