Reversing more than 30 years of policy, federal officials announced they would soon begin releasing data on how much Medicare pays to individual physicians.
Officials at the Centers for Medicare and Medicaid Services (CMS) announced Jan. 14 that they would take a "case-by-case" approach to the release of individual physician payment information, weighing the right for privacy against the value to the public in each Freedom of Information Act request they receive.
Jonathan Blum
In addition to fielding individual requests for physician data, the agency plans to generate and publish aggregate data sets on physician services.
The policy change will take effect on March 18.
"As CMS makes a determination about how and when to disclose any information on a physician’s Medicare payment, we intend to consider the importance of protecting physicians’ privacy and ensuring the accuracy of any data released as well as appropriate protections to limit potential misuse of the information," Jonathan Blum, CMS Principal Deputy Administrator, wrote in a blog post on Jan. 14.
Last May, a federal judge cleared the way for this policy shift back by lifting an injunction that had previously barred the agency from making public its database of Medicare physician claims.
The new policy has plenty of benefits, Mr. Blum wrote, including allowing providers to collaborate on better care management, giving consumers more reliable measures of quality and performance, and allowing journalists and researchers to identify Medicare waste, fraud, and abuse.
The change is also part of a broader effort at the CMS to make health care prices more transparent.
Last May, the CMS published the average charges for the 100 most common inpatient services at hospitals around the country. And in June, the agency released average charges for 30 selected outpatient procedures, ranging from echocardiograms to pulmonary tests.
Physicians’ groups have been urging caution as the CMS evaluated the release of physician data. In a Sept. 5 letter signed by the American Medical Association as well as several specialty and state medical societies, physicians said that the CMS must educate the public about the limitations of analyzing Medicare claims data. For example, Medicare claims may not include many factors that influence the cost of medical care, including specialty, location, patient mix, other demographics, and practice costs.
In the letter, the physician organizations urged the CMS to provide access to data to organizations that have experience in handling and analyzing Medicare data. And they called for the opportunity to review and correct their information in a timely manner.
"Medicare data is highly susceptible to misleading conclusions," the letter said. "CMS should undertake a detailed educational program to explain any Medicare data release program and openly address its limitations, including that the data may take into account only a small fraction of a physician’s patient population or may be outdated."