Updated Chart on BRCA Payments by Year 2014, 2015, 2016, with Natl, State, and Lab Data

I've written about the quirky range of BRCA coding and payments in different geographies under Medicare Part B.   It's a big deal; in 2016 it was about $70M payments at anywhere from $900 to $2600 per patient, depending on coding choices and MAC claims processing.   There were about 31,000 patients in CY2016, so the minimum payment would have been 31,000x$900 or about $31M, and the maximum about 31,000x$2600 or about $81M.   For most of these, a median payment would be 81432+81433 or $1400, giving $43M.

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Chart above.  Dollar data sums codes.  Utilization data assumes 81211/81213 or 81432/81433 patients overlap.   Payments are dollars allowed, including deductibles, so they are slightly less than fee schedule pricing.     Overall patient/dollar volume was up about 20% from 2014 to 2015, and up a total of about 70% from 2014 to 2016.

Data sources are:

• Provider Specific Data (to 2015; updated in June after 18 months)
• https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other-Supplier.html 
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• State Data (to 2016; updated in November after 11 months)
• https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Part-B-Carrier-Summary-Data-File/2016-Part-B-Carrier-Summary-Data-File.html 
• 
  
• National Data (to 2016; updated in November after 11 months)
• 
  
• https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Part-B-National-Summary-Data-File/Overview.html 

Data sheet, as shown in figure above, in the cloud, here.

I also charted UTAH STATE VOLUME of dollars and patients over NATIONAL VOLUME of dollars and patients.   Utah percent of total dollar volume and total patient volume appears to drop from 84% to 72% to about 40%.

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My first blog on 2016 state level data, when the data was just newly released, early November 2017, was here.  The charts above are generally a superset that gives a 2014 2015 2016 view at one glance.