HealthBlawg

David Harlow's Health Care Law Blog

  • About
  • Archives
  • Podcast
  • Press
  • Awards/Reviews
  • HIPAA
  • HCSM

Medicare Part D payments: A little more sunshine

May 4, 2015

CMS recently added another data set to its slowly growing collection of public use files. This one is a historical snapshot of 2013 Medicare Part D payments for prescription drugs. CMS has sliced and diced the data in a number of different ways, giving us some top ten lists. CMS states that this is the first time it has released such prescriber-level data.  The data set covers the two-thirds or so of Medicare beneficiaries (36 million) who had Part D drug coverage in 2013. As usual, CMS calls for the private sector to take a look at the data and analyze it in order to help transform health care. Also as usually happens when the federales release a large data set like this, organizations representing parties with vested interests in maintaining some form of the status quo are quick to caution the public that the data may be hard to understand.

CMS has released other data sets, both as part of its ongoing effort to share Medicare Provider Payment and Utilization Data and through its health care provider compare portals and datasets (see data.medicare.gov). Some news organizations have built interfaces for some of the data, to allow for easier access (see, e.g., one year’s worth of Medicare physician payment data presented by the Wall Street Journal).

Is the data released useful?

This dataset may well prove to be more interesting than the hospital chargemaster dataset released a couple of years ago.

It is certainly interesting to note which drugs are the most commonly prescribed to Medicare beneficiaries with Part D plans, and to calculate the program costs for those drugs, but one must be cognizant of the limitations of the data: they tell us limited things about limited situations, and require further interpretation and analysis. Are the drugs effective? Are the prescriptions necessary? Are there alternative approaches to managing the conditions at issue with fewer side effects and/or at lower cost? These data do not answer those questions. With waste, fraud and abuse generally estimated at 1/3 of health care expenditures, and a 2013 Part D spend north of $100 billion, further study is most definitely needed.

As an example of the sorts of tough questions that may be posed to these data, consider the analyses conducted by ProPublica using 2012 Medicare prescription drug data that raised important questions about waste, fraud and abuse. As the ultimate payors behind Medicare, we taxpayers need to remain vigilant and need to continue to ask the hard questions. (A key question with regard to Medicare and prescription drug costs would of course be: Why don’t the federales negotiate prices? The White House recently asked Congress to revisit the piece of the ACA that bars that exercise of the government’s market power.)

Update 05/18/2015: See more recent post, N of 1 – Reflections on Extracting Knowledge from Data, for one of the key limitations of these data.

One would hope that sunshine will continue to prove to be a good disinfectant.

David Harlow The Harlow Group LLC Health Care Law and Consulting

Related Posts

  • Health Datapalooza IV

    This year's Health Datapalooza was the biggest to date. This is an event that keeps…

  • CMS releases 2008 Medicare home health services payment regulation

    Pay-for-reporting, the precursor to pay-for-performance (P4P), continues to roll through Medicare payment rules for various…

  • The federales' open data policy and the Medicare hospital chargemaster data dump ... Please don't inundate us with junk.

    So just about everyone is pretty pumped about the White House announcement of its new…

Filed Under: CMS, Health care policy, Health Law, HHS, Medicare, Open Data, Open Government, Prescription Drugs

« The 2015 Google Wearables Challenge
Privacy and Security Guide released by ONC »

Trackbacks

  1. N = 1 - Reflections on Extracting Knowledge from Data says:
    May 18, 2015 at 1:43 pm

    […] top ten and the top ten by claim count and by cost in the data set recently released by CMS about Medicare Part D prescription drug plan spending in 2013. (Abilify, Advair, Crestor, Cymbalta […]

Threads

Follow me on: Threads

Mastodon

Follow me on: Mastodon

HIPAAtools

Hipaatools

The HIPAA Compliance Toolkit

The Walking Gallery

The Walking Gallery

Quick Links

  • Home
  • Categories
  • Archives
  • Podcast Interviews
  • HIPAAtools
  • HIPAA Compliance
  • Health Care Social Media
  • Speaking
  • In the Press
  • Blogroll

David Harlow

David Harlow

HealthcareNOW Radio

  • Subscribe
  • Contact
  • Book Me: Speaking
  • About
  • The Harlow Group LLC
Copyright © 2006–2025
HealthBlawg is a publication of The Harlow Group LLC. See Copyright notice and disclaimer.
Fair use with attribution and a link is encouraged. Click for more on David Harlow.
[footer_backtotop text="Back to top" href="#"]