CMS To Publicly Release Medicare Physician Payment Data

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On Wednesday, the Obama administration announced that it will release Medicare physician payment data to the public for the first time, the New York Times reports (Abelson, New York Times, 4/2).

According to HHS, the data will be released on April 9.

Background

Administration officials said the data will be released in response to various requests filed under the Freedom of Information Act (Morgan, Reuters, 4/2). HHS in January published a notice in the Federal Register announcing that CMS will begin to respond to such requests for Medicare physician payment data.

The policy change came after a federal judge in May 2013 lifted a 33-year-old injunction that barred the government from giving the public access to a confidential database of Medicare insurance claims.

The court injunction stemmed from a lawsuit that the American Medical Association and the Florida Medical Association filed to prevent former President Jimmy Carter's administration from publishing a list of annual Medicare reimbursements.

The database, known as the Carrier Standard Analytic File, contains information on physicians and other health care providers participating in Medicare who are paid on a fee-for-service basis. It incorporates all physician claims that Medicare paid directly (iHealthBeat, 1/21).

Data Details

The data will include information on payments made under Medicare Part B in 2012 to all providers who participated.

Specifically, the data will include:

  • Physicians' names and addresses;
  • Summaries of the services provided; and
  • The amount providers were paid for the services (Reuters, 4/2).

The data will not include any patient information (New York Times, 4/2). Further, CMS will not release any information on providers with fewer than 11 patients who are Medicare beneficiaries (Viebeck, "Healthwatch," The Hill, 4/2).

In total, the data will list details of more than $77 billion in Medicare payments to more than 880,000 providers for about 6,000 different procedures and services (New York Times, 4/2).

Push for Transparency

According to the Wall Street Journal, the release aims to spur greater transparency and promote fraud discovery (Radnofsky, Wall Street Journal, 4/2).

In addition, CMS Principal Deputy Administrator Jonathan Blum in a blog post wrote that the data will "shine a light on how care is delivered in the Medicare program" while "help[ing] consumers compare the services provided and payments received by individual health care providers." He added, "Businesses and consumers alike can use these data to drive decision-making and reward quality, cost-effective care" (New York Times, 4/2).

According to "Healthwatch," the data release also is aimed at allowing researchers to use the data to study trends in health care ("Healthwatch," The Hill, 4/2).

Providers Push Back

Physicians have expressed concern that the data could unfairly reflect poorly on some providers, such as those practicing in low-income areas where patients experience negative outcomes because they cannot afford the cost of medication or copayments or do not complete basic follow-up care. In such instances, the data might negatively portray providers who are providing adequate care, physicians say (Alonso-Zaldivar, AP/Sacramento Bee, 4/3).

The American Medical Association in response to an April 2 letter from Blum again expressed its opposition to the data release. In a statement on Tuesday, AMA said "that CMS' broad approach to releasing physician payment data will mislead the public into making inappropriate and potentially harmful treatment decisions and will result in unwarranted bias against physicians that can destroy careers." The group suggested that CMS allow physicians to review and correct the data before its release (Carlson, Modern Healthcare, 4/2).


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