Skip to content

bfetler/cms_medicare

Repository files navigation

Center for Medicare Services Data

The Center for Medicare Services (CMS) has provided public datasets for many different aspects of healthcare, in an attempt to make the U.S. healthcare system more transparent. The most recent healthcare provider data from 2014 is available in the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File.

The file contains annual data from over 980,000 physicians and other healthcare providers, including:

  • provider type
  • provider location
  • total cost of submitted claims
  • total Medicare payment amount
  • total number of services (doctors visits or procedures)
  • total number of beneficiaries (patients)
  • some drug costs (full drug data is in other datasets)
  • provider and patient gender
  • summary of anonymized beneficiary information

Preliminary Analysis

To get an idea of actual health care costs for consumers, we did a preliminary analysis of the total Medicare payment amount per service and per beneficiary. Typically, a beneficiary has supplemental insurance to cover the remainder of the claims, which often pays 20% of the approved Medicare payment. Extra costs are typically fixed at a fraction of the approved payment. We calculated two extra columns:

  • payment per service = log10 ( total Medicare payment amount / total number of services )
  • payment per person = log10 ( total Medicare payment amount / total number of beneficiaries )

We find a log scale gives data closer to a normal distribution, and use log base 10 for numerical convenience. Grouping the payments by the 91 provider types in the data, we find a lot of variation for each provider type. Histograms for all provider types are given in cms_hist_plots/. A histogram of some specialties is shown below.

example histogram per person

A good number of provider types have well-defined costs that follow a log normal distribution, while others have a lot of variation. Some categories have very few providers, for whom it is difficult to do statistics. Nonetheless, we find some trends by provider type.

Payment Per Service

Of the top dozen provider types by median payment per service, nine are for Surgery, with the most expensive being Ambulatory Surgery, and three are for Radiation or Oncology. A summary is given in the table and figure below.

Provider TypePayment Per Service (USD)
Ambulatory Surgical Center457
Cardiac Surgery353
Thoracic Surgery262
Neurosurgery220
Surgical Oncology167
Plastic and Reconstructive Surgery164
Radiation Therapy155
Colorectal Surgery152
General Surgery145
Anesthesiology131
Vascular Surgery125
Gynecological/Oncology118

bar plot per service

Payment Per Beneficiary

Of the top dozen provider types by median payment per beneficiary, two are for Radiation or Oncology, with the most expensive being Radiation Therapy, and five are for Surgery, as shown in the table and figure below.

Provider TypePayment Per Person (USD)
Radiation Therapy7039
Cardiac Surgery934
Ambulatory Surgical Center893
Psychologist (billing independently)867
Radiation Oncology830
Thoracic Surgery689
Ambulance Service Supplier580
Clinical Psychologist571
Neurosurgery549
Physical Therapist529
Plastic and Reconstructive Surgery500
Speech Language Pathologist463

bar plot per person

For consumers, the payment per person is probably of most interest, since a patient is typically prescribed a series of treatments, not just a single service.

Medicare Total Beneficiaries and Payment

The total number of medicare beneficiaries by provider type is shown below. This gives some idea of the most and least popular care options provided by Medicare. Diagnostic Radiology, Internal Medicine, Clinical Laboratory and Cardiology are in the top five most popular.

bar plot total beneficiaries

The total medicare payment by provider type is shown below. This gives some idea of the most and least expensive care provided by Medicare. Internal Medicine, Ophthalmology, Clinical Laboratory and Cardiology are in the top five most expensive.

bar plot total payment

Medicare Payment By State

Absolute cost per person of each provider type is shown above in the figure "Median Log10 Pay Per Person".

To show relative cost, maps of median cost per person by state were created for provider types. Three common provider types are summarized below:

  • Physical Therapist (expensive, $509 USD)
  • General Surgery (intermediate, $338 USD)
  • Internal Medicine (inexpensive, $207 USD)

The absolute cost per person may seem counterintuitive, but is due to the number of sessions for treatment. For example, General Surgery takes on average 2.4 sessions, while Physical Therapy takes 25 sessions.

Below, a median color of red was used for each map, showing relative cost by state. More expensive states trend purple, while less expensive states trend yellow.

median cost per person by state for physical therapist

median cost per person by state for general surgery

median cost per person by state for internal medicine

Some of the western states such as Utah and Montana appear to be expensive for Surgery, while the northeast, California and Florida appear to be generally expensive.

Provider Gender

We further analyzed the data by provider gender, with some types of facilities categorized as neither. In general, we find some specialties have a sizeable gender gap, while others do not. This somewhat reflects traditional roles in society, with more female nurses and more male surgeons.

gender count bar plot

We also find that female providers generally cost less than male providers, depending on specialty. Consumers who choose female providers may see reduced costs. On the other hand, the data also may indicate a persistent wage gap among female providers. The median cost ratio is less than 20% for 80% of providers.

gender cost ratio bar plot

gender cost ratio scatter plot

Here is an example plot of a histogram of log costs by provider gender. There does not appear to be a large difference in cost distribution based upon gender for most provider types.

gender cost histogram plot

Patient Age

We have data on average patient age, and age broken into four categories, which we can group by provider type. The information is not broken down into cost per service by age, but it is still interesting to consider the popularity of different specialists by age.

beneficiary average age by provider

Apparently Psychiatry is needed more by people in their mid-50's, while Radiation Oncology is more common in the mid-70's.

beneficiary age subgroup

Patient Gender

Patient gender also affects the types of medical procedures needed. The results are for total population.

beneficiary gender subgroup

Conclusion

Health care costs are a sobering reminder for consumers and anyone concerned with health care in the U.S.

About

Center for Medicare Services Data

Resources

Stars

Watchers

Forks

Releases

No releases published

Packages

No packages published

Languages