Bah, Humbug: 4 Coals in Your Stocking in 2014

Leigh Page


January 02, 2014

In This Article

Is Transparency Always Beneficial?

4. Public Disclosure of Medicare Reimbursements

In August, CMS announced it would disclose Medicare fees to the public, and the agency asked for input on how fees should be reported. The announcement followed a federal judge's decision in May to lift a 34-year-old injunction against revealing Medicare fees.

Physicians appear to be split on the issue. A survey[9] of members by the American College of Physician Executives (ACPE) found that 46% opposed and 42% were in favor of public disclosure. Whereas those opposed were concerned it might damage their competitive footing, those in favor said the public had a right to know. Several physicians in the ACPE survey -- both those were for and those who were against disclosure -- were asked to comment for Medscape, but only those opposed agreed to do so.

"This releases gigantic amounts of information on individual practices, which is a disadvantage in a competitive environment," said James C. Salwitz, MD, an oncologist at Regional Cancer Associates, a 92-member group in New Jersey. Dr. Salwitz said large cancer practices looking to move into New Jersey could use payment data on his practice to determine the kinds of patients it was treating. "You can learn an immense amount about the internal goings-on of a practice from payment data," he said.

The prospect of fee reporting is "a little scary when you're not sure how it will be done," said Kenneth Maxwell, MD, an otolaryngologist at a 9-physician practice in Winston-Salem, North Carolina. Although there is no variation in Medicare charges for the same service in the same locality, he said he is concerned that payment reports could identify physicians' charges for extra services.

Dr. Maxwell said his practice does not order unnecessary tests, but a practice in another Southern city routinely orders a whole battery of expensive tests. Even though disclosure would expose the competitor's wasteful practice, he said he still opposed the new CMS policy because there would be times when ordering another test might be construed as wasteful when actually it is not.

Major physician organizations have communicated to CMS advice on how physicians' fees should be disclosed. It is too early to know how CMS will go about reporting the fees or even when it will happen, but in any case, physicians should be on the lookout for errors when the reports are released.

In a world as diverse as physician practice, it's hard for everyone to agree on what is good and what is bad, but no doubt physicians will do some struggling to adapt to some of the new mandates.


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