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Medicare Part B data made available to the public: A wealth of information, but approach with care

Benjamin Scher, Kathleen Twigg, and Andrew Huson
July 2014
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The Centers for Medicare & Medicaid Services recently made available to the public for the first time detailed data from 2012 regarding the Medicare Part B program: More than 9 million records of data for more than 880,000 healthcare providers including the services provided, the drugs administered, and the amounts paid for those services and drugs by the Medicare Part B program. As a result of the data release, high-billing doctors, particularly ophthalmologists, have received considerable scrutiny by the press.

The authors examine two competing hypotheses regarding ophthalmologists’ use of the drugs Lucentis and Avastin. In particular:

  • Do ophthalmologists that administer Lucentis do so because they earn higher profits, as has been suggested in the press? 
  • Do ophthalmologists exercise medical judgment on a patient-by-patient basis and administer Lucentis because it is the best choice in certain instances?

The paper was featured in the November 12 PharmExec article titled "Medicare Part B Data: Approach with Care."