A New Day for Transparency: CMS Releases Medicare Physician Data Files

Brian Klepper
After decades of secrecy, the Centers for Medicare and Medicaid Services (CMS) has released files on charges and paid amounts to 880,000 medical providers who received $77.4 billion in 2012.

It is likely that these are aggregate data, lacking the individual claim detail that would help purchasers identify which providers consistently deliver the highest quality care at the lowest episodic cost. But CMS' release indicates that they no longer believe that physicians have a right to privacy when it comes to public expenditures for their services, which could mean that, in the future, more granularity will be forthcoming.

This is potentially a hugely disruptive health care innovation. Commercial health plans consider claims data proprietary and have jealously protected it. Having an alternative, credibly sized data source in the Medicare provider file will allow purchasers to conduct comparative analyses to determine high and low performers. In turn, this new level of value transparency will translate to market pressure on the medical community to demonstrate efficacy.

Here's a USA Today article on the release, and here's the page where you can download the files.