The Centers for Medicare and Medicaid Services has released new data on Medicare Part D prescription drugs prescribed by physicians and other health care professionals in 2013, revealing which prescription drugs were prescribed to Medicare Part D beneficiaries by which practitioners.
According to CMS, the new datasetcreated from drug claims submitted by Medicare Advantage Prescription Drug plans and stand-alone Prescription Drug Planscontains information from over 1 million distinct healthcare providers who collectively prescribed approximately $103 billion in prescription drugs and supplies paid under the Part D program. For each prescriber and drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost paid by beneficiaries, Part D plans, and other sources.
This transparency will give patients, researchers, and providers access to information that will help shape the future of our nations health for the better, said acting CMS Administrator Andy Slavitt. Beneficiaries personal information is not available; however, its important for consumers, their providers, researchers, and other stakeholders to know how many prescription drugs are prescribed and how much they cost the healthcare system, so that they can better understand how the Medicare Part D program delivers care.
CMS argues that by using this data, it will be possible to conduct a wide array of prescription drug analyses that compare drug use and costs for specific providers, brand versus generic drug prescribing rates, and to make geographic comparisons at the state level. However, the American Medical Association is critical of the Medicare Part D data release for a myriad of reasons:
*The data does not account for varying strengths or dosage levels of the medications or varying patient needs.
*The data does not provide information on generic substitutions for branded medications.
*The data does not include explicit information linking treatment to the quality of care provided, but focuses solely on payment and utilization so it should not be used to evaluate care provided.
*The pharmaceutical cost information does not include manufacturer coupons or rebates that often help mitigate out-of-pocket costs for patients. There could also be price differences depending on where a patient gets his or her prescription.
*The data is incomplete because it does not include instances where there were less than 10 claims for a certain treatment for a particular provider.
*The data does not include treatments paid for by private insurance plans, for patients not covered under Medicare Part D or Medicaid beneficiaries making it a limited view of the patients a physician cares for that could lead to misrepresentations and invalid calculations.
*And, there is a lack of specificity in specialty descriptions and practice types in the data, which could be misleading when making comparisons between physicians.
The American Medical Association is committed to transparency and the availability of reliable information for patients to make informed decisions about their medical care, said AMA President Robert M. Wah, M.D. But, according to Wah, the data released is much more complex than initially meets the eye and the limitations of it should be more comprehensively listed and highlighted more prominently so that patients can clearly understand them.
AMA is troubled by the lack of context provided with the data that could help explain physician prescribing practices and pharmacy filling practices before conclusions are drawn, explains Wah, who argues that accurate understanding of Medicare data is critical to both physicians and patients. In addition to improving transparency with the public, we are also calling on the Centers for Medicare and Medicaid Services to provide accurate, timely and actionable data to physicians that will support the implementation of new delivery and payment models that can improve patient care.
This isnt the first time AMA has criticized CMS for releasing data without context. Last year, Medicare publicly posted 2012 Part B payment information on more than 880,000 physicians and other billable professionals in all 50 states.
But, the AMA argued that the data has significant shortcomings regarding the accuracy and value of services rendered by physicians. In addition, because the data exists in raw forms that require interpretation and context, to make an impact on the average consumer it must be presented in ways that they can understand.
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