Medicare Will Reveal Individual Doc Pay Starting Mid-March

January 14, 2014

In a move that worries organized medicine, the Centers for Medicare & Medicaid Services (CMS) announced today that it will begin to disclose how much Medicare pays individual physicians on a case-by-case basis in response to requests under the Freedom of Information Act.

The agency said it will "weigh the balance between the privacy interest of individual physicians and the public interest in disclosure of such information." In the process, it will guard the privacy of Medicare patients.

The new policy takes effect 60 days after its publication today in the Federal Register.

Opening Medicare's checkbook down to the individual provider level is the latest government effort to make healthcare more transparent to the general public. This fall, CMS will launch a Web site where it will post payments and gifts that physicians receive from drug and device makers. In addition, CMS will expand its Physician Compare Web site this year to include quality-of-care information for clinicians in group practices.

The decision to reveal, in some cases, what Medicare pays individual physicians is the culmination of a decades-old dispute about what the public ought to know. The predecessor of the Department of Health and Human Services proposed a similar plan in the 1970s only to have a federal district judge in Jacksonville, Florida, slap a permanent injunction on it in 1979 because, in his view, it violated a law called the Privacy Act. In May 2013, however, US District Judge Marcia Howard in Jacksonville lifted the injunction, saying that the federal judiciary interprets the Privacy Act differently than it did in 1979. The American Medical Association (AMA) had fought to preserve the injunction.

Payment Data Can Be Misinterpreted, Say Medical Societies

 

After last May's crucial court decision, CMS invited the public for advice on when and how to reveal what Medicare pays a particular physician. The agency received more than 130 comments, including a good number from the medical profession.

One physician called the idea of disclosing individual reimbursement "punitive."

"My voice is small, but you need to know that a lot of my peers are quitting, and there is no one there to replace them," the physician wrote.

"Releasing physician payment data will do nothing but create an adversarial relationship between patients and their doctors and not lead to greater fraud detection," wrote another clinician. "Many of our local doctors have already dropped Medicare and Medicaid as payers simply out of frustration with attacks on our profession such as this."

A letter signed by the AMA and dozens of other national and state medical societies struck a hopeful note by saying that "if used correctly," Medicare claims data could improve the quality of care. Then the societies ticked off various ways the information could be misused and misunderstood, unless the necessary safeguards were adopted.

For example, patients might misinterpret a physician's Medicare compensation if they are not privy to how much it costs him or her to run a practice. In other words, revenue doesn't equal income. Any release of payment data, therefore, should be accompanied by caveats about its limitations, according to the medical societies.

The AMA and its allies also asked CMS to allow physicians to review Medicare payment data and correct any errors before it enters the public realm lest they suffer harm to their reputations and livelihood.

To illustrate how compensation data can be misleading, Donald Fisher, PhD, the president of the American Medical Group Association, presented CMS with a scenario of a salaried surgeon in a group practice. The surgeon generates a hefty amount of Medicare revenue in part because a physician assistant frees him to spend more time in the operating room. A potential patient could look at this surgeon's reimbursement data and conclude that he earns more than he actually does.

"The emphasis on individual physician-level data is a relic of an outdated care model and a fragmented healthcare delivery system," Fisher wrote CMS. In addition, he warned that releasing a physician's Medicare pay could make him or her the target of "unwanted marketing attempts" or "criminal activity."

Journalists Have Sought Robust Disclosure

While organized medicine has urged CMS to proceed cautiously with its new disclosure policy, others want it to go full speed ahead.

Dow Jones, the publisher of the Wall Street Journal, said during the policy comment period that greater transparency would help journalists and watchdog organizations ferret out fraud, waste, and abuse in Medicare.CMS should release payment data "as broadly and granularly as possible," said the company, which had sued in federal court to lift the injunction against making the information public.

A coalition of groups that included the Society of Professional Journalists, Public Citizen, and the Center for Public Integrity chimed in by saying that medical practices are like any other business that receives federal dollars — they're not entitled to privacy. The coalition urged CMS to go a step further and create a publicly accessible database of Medicare reimbursement so anyone could look up what an individual clinician earned.

The new policy announced today by CMS gave no indication, however, that such a database is in the works.

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