How Should CMS Disclose Individual Physician Pay?

August 14, 2013

In the new age of healthcare transparency, the Centers for Medicare & Medicaid Services (CMS) is asking the public how and when it should disclose what individual physicians receive from Medicare.

The deadline to give advice to the agency is 5 pm ET September 4.

The medical profession increasingly finds itself in a federally built house of glass, whether it is the healthcare reform requirement that drug and device makers report their payments and gifts to physicians or the Physician Compare Web site that will eventually include quality-of-care information. In May, the house of glass expanded when a federal judge lifted a 33-year-old injunction against publicly revealing Medicare payment data for individual physicians. The ruling represented a defeat for the American Medical Association, which argued that the injunction should remain in force.

Last week, CMS announced it is seeking public comment on "the most appropriate policies" for disclosing what physicians receive from Medicare.

The agency said when someone requests an individual physician's payment data, it is now obliged to share it under the Freedom of Information Act unless an exemption applies. One such possible exemption is an unwarranted invasion of a physician's privacy. Accordingly, CMS said it would consider "whether the public interest in disclosure outweighs the physician's privacy interest in the information." Notions about a physician's privacy interest, it said, have changed since 1979 for a number of reasons:

  • Growth in Medicare spending has whetted public appetite for more information.

  • The Affordable Care Act already authorizes the release of a physician's payment data to qualified entities such as consumer groups and employers wanting to measure physician performance.

  • Medicare pay to physicians is more standardized.

  • Disclosure of what physicians receive from Medicare could help the government battle rampant Medicare fraud, abuse, and waste.

At the same time, CMS said that it is committed to "more data transparency," particularly as crunching the numbers can improve the quality of healthcare while lowering costs.

CMS wants the public to answer 3 questions to help it apply transparency to Medicare reimbursement:

  • Do physicians indeed have a "privacy interest" in their Medicare payment data, and if so, how should CMS balance that privacy interest with public interest in that information?

  • What specific disclosure policies should CMS consider to improve patient care, lower costs, and otherwise promote the public good?

Comments can be submitted via email to Physician_Data_Comments@cms.hhs.gov. More details and alternative methods for comment submission to CMS by the September 4 deadline are available on the agency's Web site.

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