Datapalooza: HHS Unveils Medicare Outpatient Costs

Scott Mace, for HealthLeaders Media , June 4, 2013

The latest release of data was applauded by researchers and developers attending Datapalooza, but one hospital cost analyst notes that the newly-released data still represents but a sliver of the total amount of data CMS should release eventually, and for now leaves the bulk of that work to application developers.

"I'm deliriously happy to see all of the transparency going on at this conference," says Jeanne Pinder, a former New York Times editor and now founder and CEO of, a healthcare cost search engine funded in part by the Tow-Knight Foundation. "It's only a fraction of what we need. It's a tiny fraction. It's not actionable, shoppable information that would help real-live consumers."

Pinder adds that every time a little bit more data is released, it begins another piece of a larger conversation. "Why does it look like this? Why is it so crazy? Why are the charges disconnected from the payments? Why can't we as real live human beings who are interested in making decisions about our health have real information? Ms. Sebelius is on the side of the angels, but we need more data."

Specifically, HHS built on the release last month of the average charges for the 100 most common inpatient procedures by releasing selected hospital outpatient data that includes estimates for average charges for 30 types of hospital outpatient procedures from hospitals across the country, such as clinic visits, echocardiograms, and endoscopies.

CMS also released new data sets for the first time at the county level: one on Medicare spending and utilization, and another on Medicare beneficiaries with chronic conditions. Both data sets will enable researchers, data innovators, and the public to better understand Medicare spending and service use, spurring innovation and increasing transparency, while protecting the privacy of beneficiaries. The data will also be available through an interactive state level dashboard based on the spending information, allowing users of any skill level to quickly access and use the data.

Scott Mace is senior technology editor at HealthLeaders Media.

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1 comments on "Datapalooza: HHS Unveils Medicare Outpatient Costs"

flpoggio (6/7/2013 at 7:09 PM)
"Why does it look like this? Why is it so crazy? Same reason I gave in an earlier post. In case you missed it: Yes hospital charges are non-sense, all over the map, not based on logic, etc. All true. But how'd that happen. As a former CFO I can tell you it was all done via the Medicare Cost Report, the core basis of Medicare payment system. For almost five decades the government has used the Cost Report, and a myriad of other convoluted reimbursement systems, to calculate payments to hospitals. So over the decades any good CFO would make sure that his charges maximized his governmental payments. And Medicare and Medicaid usually make up 60% of the total payments. Some fifty years ago charges became a substitute for statistics and cost accounting to estimate how much the government was going to pay you. Ever hear of RCCAC? That's the Ratio of Costs to Charges as Applied to Costs, a key calculation in the Cost Report. One of the most insane ways of 'identifying' costs ever cooked up. And it's still used today! Hospitals get paid based on DRGs, but still must do a Cost Report to justify the DRG amounts. I was around in 1983 when the feds came up with DRGs, they said back then the DRG system would replace the Cost report...and here we are 30 years later- with both! If you want to know why charges are a mess...just look at the Cost Report, and ask who created that monster? Maybe CMS should release a 'history' of CMS??




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