Medicare billed $90 billion for inpatient, outpatient services in 2013, new data show

Ambulance at an emergency room (stock photo)

The Centers for Medicare and Medicaid Services on Monday posted new data on what hospitals billed and how much they were paid for the most common inpatient and outpatient procedures in 2013.

Over 950,000 healthcare providers collectively received $90 billion in Medicare payments, according to the report.

[See prices for top 100 inpatient services]

The data shows what hospitals charged and what Medicare paid for the 100 most frequently billed inpatient stays and the 30 most common outpatient procedures at more than 3,000 hospitals nationwide.

[See prices for top 30 outpatient services]

Users are able to make comparisons between the amount charged by an individual hospital for a particular service, within a local market, and nationwide.

The top 100 inpatient stays are associated with approximately $62 billion in Medicare payments and over 7 million hospital discharges, according to the report.

Hospitals, physicians, and other health care providers determine what they will charge for services and procedures provided to patients. These charges are the amount the hospital or provider generally bills, but the amount paid is determined by Medicare’s physician fee schedule or other payment methodologies, according to CMS.

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The report details how much Medicare paid doctors in 2013, allowing for comparison by physician, specialty, location, type of medical service and procedure delivered, Medicare payment, and submitted charges.

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 healthcare professionals.

The report adds to information recently released on Medicare Part D prescription drugs prescribed by physicians and other health care providers.

Shortly after CMS released its findings, the American Medical Association released a statement saying the data has several shortcomings, including no explicit information on the quality of care provided or quality measurement, according to the AMA.

"It solely focuses on payment and utilization of services so it cannot be used to evaluate the care actually provided," the AMA stated.

AMA President Robert M. Wah said,"It also does not provide enough context to prevent the types of inaccuracies, misinterpretations and false assertions that occurred the last time the administration released Medicare Part B claims data."

Among the AMA's concerns, is that data being released may contain errors because there is currently no mechanism for physicians and other providers to review and correct their information.

The AMA is committed to transparency, with healthcare data to be discussed during the AMA's annual meeting this month, according to Wah.

[Also: CMS spent $103 billion on Medicare Part D in 2013, $2.5 billion on Nexium]

The agency will continue to release hospital and physician data annually in its efforts to increase price transparency and reduce costs  as it moves away from paying providers for fee-for-service to a reimbursement system based on value, according to CMS.

“Data transparency facilitates a vibrant health data ecosystem, promotes innovation, and leads to better informed and more engaged health care consumers,” said CMS Chief Data Officer Niall Brennan in a statement. “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 healthcare system.”

Twitter: @SusanMorseHFN