Medicare Claims: Will Everyone Know How Much You're Paid?

Leigh Page


March 20, 2014

In This Article

What Applicants Want With the Data

Although CMS is very guarded about how it will release the information, a wide variety of groups will probably submit a mountain of requests for it, according to Michael J. Stuart, manager of business development at Kyruus, a Boston company that mines data to help patients find the right provider.

"CMS is basically sitting on an incredible mine of data that could be utilized to better understand healthcare," Stuart said. For data miners such as Kyruus, the information is virgin territory. Until now, the company has been limited to data from hospital networks, commercial payers, and Medicaid, which isn't as extensive and often doesn't provide enough detail to draw solid conclusions about physicians' practice patterns.

Many physicians, however, don't have a clear idea what these groups plan to do with their claims data. In comments to CMS about its new policy, for example, many doctors were concerned that their actual reimbursements would be publicly posted.[6] They pointed out, quite rightly, that this would be misleading; reimbursements aren't the same as take-home pay, and Medicare represents just part of their total reimbursements. "My overall Medicare reimbursement would probably greatly exaggerate my actual 'salary,' perhaps several-fold," one physician told CMS. "I don't consider it the business of my patients to know such things."

In fact, reimbursement amounts were more interesting back in the 1970s, before physician data were locked away. Back then, doctors could balance-bill Medicare, charging patients more than the government's recognized price. In 1976, the Health Care Financing Administration, the precursor to CMS, published each physician's Medicare charges in an effort to shame those who charged extra, and it was this information release that prompted the 1979 court decision to lock up the data.

Today, however, publishing straight reimbursement data holds little interest to some potential data-users. Robert Krughoff, President of Consumers' Checkbook, which rates a variety of service providers (including physicians), lost a lawsuit in 2007 to obtain the data from CMS.[7] Krughoff said he has "no interest whatsoever" in posting reimbursement income. "Even if we could measure what a physician makes, that is not meaningful data for consumers," he said. Instead, he would like to use the data to identify physicians who have performed certain procedures enough times to be skilled at them.


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