CMS to Soon Reveal How Much Medicare Pays Individual Doctors

Mark Crane

April 04, 2014

Over the longstanding objections of leading medical groups, the Centers for Medicare & Medicaid Services (CMS) will begin disclosing — as soon as April 9 — how much Medicare pays individual physicians and other healthcare providers.

"We plan to provide the public unprecedented access to information about the number and type of health care services that individual physicians and certain other health care professionals delivered in 2012, and the amount Medicare paid them for those services," according to an announcement from CMS Principal Deputy Administrator Jonathan Blum.

The data contain information on more than 880,000 healthcare professionals in all 50 states who collectively received $77 billion in payments in 2012 for services delivered to beneficiaries under the Medicare Part B Fee-for-Service program. More than 6000 different types of services and procedures will be included, and the data are expected to highlight physicians with suspicious billing patterns.

"Release of physician-identifiable payment information will serve a significant public interest by increasing transparency of Medicare payments to physicians...and shed light on Medicare fraud, waste and abuse," Blum wrote in an April 2 letter to the American Medical Association and Florida Medical Association.

CMS will not publicly release any information that could potentially identify specific beneficiaries and will redact all data in cases where it includes fewer than 11 beneficiaries to further protect their identities.

The federal government proposed a similar plan in the 1970s, but a federal district judge in Jacksonville, Florida, said it violated a privacy law and issued a permanent injunction. In May 2013, another federal judge lifted the injunction over the objections of the American Medical Association.

"Date Will Mislead the Public"

Reid Blackwelder, MD, president of the American Academy of Family Physicians, called on CMS to grant physicians the right to review data about themselves before it is released.

"We agree that transparency is extremely important, but we want to be sure the data have some context," he told Medscape Medical News. "Just looking at numbers without understanding what they mean can be confusing for patients. The entire context of the practice is important as well as regional differences. It doesn't look like that will be included in what CMS is releasing."

The AMA and American Osteopathic Association agree. "The AMA is concerned that CMS' broad approach to releasing physician payment data will mislead the public into making inappropriate and potentially harmful treatment decisions and will result in unwarranted bias against physicians that can destroy careers. We have witnessed these inaccuracies in the past," AMA President Ardis Dee Hoven, MD, said in a statement.

Physicians should be permitted to review and correct their information before the data release, she said. "Taking an approach that provides no assurances of accuracy of the data or explanations of its limitations will not allow patients to draw meaningful conclusions about the quality of care."

The American Osteopathic Association (AOS) also urged CMS to "exercise caution" in releasing physician payment data. "When raw data are presented to the public, they can very easily lead to false conclusions and greater confusion, which seems to contradict CMS' intent to empower the public through education," AOA President Norman Vinn, DO, said in a statement. "We strongly urge CMS to consider the impact and unintended consequences this policy might have for physicians and their patients."

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