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

Leigh Page


March 20, 2014

In This Article

When Will the Data Be Posted?

Of immediate concern to physicians are the plans in the SGR repeal bill to post the data on Physician Compare starting on July 1, 2015.

The bill doesn't say exactly what data CMS would post, but it does address at least some of the concerns that the American Medical Association and other physician organizations raised in their letter to CMS. For example, the bill would give physicians an opportunity to review the information and submit corrections before posting, and postings would include a wide-ranging disclaimer -- saying, for example, that the data do not include the physician's non-Medicare patients or account for "the health conditions of individuals treated."

Not everyone is satisfied with this arrangement. Peter Hanson, MD, an orthopedic surgeon who reviews physician performance data as a member of the quality committee of Sharp HealthCare, a hospital system based in San Diego, said he's leery of putting CMS in charge.

"I don't trust CMS to provide accurate data,'" he said, noting that the agency has made mistakes as a payer. He added that CMS needs to carefully choose what data it puts on Physician Compare, because it won't be possible to report the same measure for all specialties, and some would be easier to report than others. For example, Dr. Hanson said surgical procedures are focused on a single event, which makes them relatively easy to measure, whereas management of a patient with diabetes never stops and would thus be more difficult to measure.

Considering the mood on Capitol Hill, simply not posting the data may not be an option. Whereas both parties are warring over the Affordable Care Act, they're remarkably in agreement on this issue. In calling for release of the data, Sen Chuck Grassley (R, Iowa) said, "If doctors know that each claim they make will be publicly available, it might deter some wasteful practices and overbilling."[13]


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