April 03, 2014
Area(s) of Interest: Payor Issues and Reimbursement Public Payors
The Centers for Medicare and Medicaid Services (CMS) announced yesterday that it would soon begin publishing individual Medicare physician billing data, despite objections from the American Medical Association (AMA) and other provider groups. CMS intends to publicly post the data as early as April 9.
The release will cover some $77 billion worth of Medicare Part B payments made to physicians in 2012 and will include physicians’ provider IDs, their charges, their patient volumes and what they received in reimbursements from Medicare. Individual patient level data will not be released. The information released will include data on 6,000 types of services and procedures that will allow data analysts to pinpoint outliers in charges and volume.
For more than three decades provider groups have successfully argued that such data could reveal proprietary details about physicians’ practices and could cause harm to doctors by publishing inaccurate or misleading presentations of the data.
Last May, however, a federal judge lifted a 33-year-old injunction that prohibited CMS from releasing any individually identifiable payment information. After the injunction was lifted, AMA had urged CMS to ensure the information be released only for purposed intended to improve the quality of Medicare services and to set appropriate safeguards.
Despite these concerns, CMS said yesterday that individual Medicare payment data on 880,000 health care providers, including 550,000 physicians, would be made publicly available as early as next week.
“Release of physician-identifiable payment information will serve a significant public interest by increasing transparency of Medicare payments to physicians and shed light on Medicare fraud, waste and abuse,” wrote Jonathan Blum, principal deputy administrator for CMS in an April 2 letter to AMA.
While the AMA is “committed to transparency” and supports the release of some physician data, the group is urging CMS to give physicians the opportunity to review and correct their information prior to its public release.
“The AMA is concerned 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,” said AMA President Ardis Dee Hoven, M.D., in a statement released late Tuesday.