Spring 2015 issue of Horizons

states have mandated global data sharing in the form of all-payer claims databases (APCDs), and other healthcare providers have formed ACOs, as mentioned previously. However, there is no federal standard in place. This has left many industry analysts looking to the volumes of publicly available information collected by the Centers for Medicare & Medicaid (CMS). In April 2014, CMS began releasing Medicare provider utilization and payment data. Hospital-specific data is also available for select inpatient and outpatient charges across more than 3,000 U.S. hospitals. Later in 2014, CMS made a “wave” of drug and device company payments available to teaching hospitals and physicians. With a little digging and know how, anyone can head to the CMS website to download the Medicare provider utilization and payment data set containing information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The data set, which is based on CMS’s national claims history standard analytic files, provides detail on Medicare Part B services and physician payments received on behalf of Medicare fee-for-service beneficiaries. Specifically, the information provided focuses on Medicare fee-for-service payments made to physicians and suppliers for Part B, non- institutional items after all claim adjustments have been resolved, excluding durable medical equipment data. CMS has also provided public use files covering fees charged for the top 100 most frequently billed discharges across over 3,000 U.S. hospitals that receive Medicare payments.

beneficiary payer claim payments, Part A coinsurance, deductible amounts and DRG outlier amounts. Information is provided as an average Medicare payment for each of the top 100 discharges by hospital. CMS has stated that the information can be utilized to “make comparisons between the amount charged by individual hospitals within a local market, and nationwide, for services that might be furnished in connection with a particular inpatient stay.” Healthcare Manufacturing Companies Similar to the inpatient information, CMS has made outpatient data on 30 ambulatory payment classification (APC) groups available as well. This outpatient Medicare payment data includes the APC payment, Part B coinsurance and deductible amounts. Again, this information is provided at the individual hospital level. As part of the federal Open Payments Program, CMS also released a data set containing payments or other transfers of value between manufacturers and group purchasing organizations (GPOs). As an example, one could filter the provided information for a particular teaching hospital to analyze the payments received by the individual manufacturing companies.

This payment data includes diagnosis related group (DRG) amounts, per diem amounts,

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