CMS Denies Request for Medicare Physician Reimbursement Information

CMS has denied a request from Business Roundtable, which represents CEOs from 160 of the largest U.S. companies, to disclose information on the cost and quality of care provided by individual physicians to Medicare beneficiaries, the New York Times reports. Business Roundtable, whose member companies provide health insurance to more than 25 million employees, requested the information to direct workers, retirees and their dependents to physicians who had the best results and offered the best value of care.

According to Bush administration officials, who have encouraged private health insurers to disclose health care cost and quality information, a 1979 federal district court decision prevents the disclosure of data on Medicare reimbursements to individual physicians under the Privacy Act. However, employers maintain that the court decision no longer applies because CMS has changed Medicare reimbursement practices and because today most physicians practice in professional corporations, which the Privacy Act does not protect.

"Times have changed," Peter Lee, CEO of Pacific Business Group on Health, said, adding, "The administration should take a hard look at that case and its outdated interpretation of the privacy law."

Christina Pearson, a spokesperson for HHS, said the Bush administration has begun to review the court decision.

Robert Lane, chair of Deere, said that CMS "should release 100% of the Medicare claims database" because the information "is essential to measuring cost efficiency and compliance with clinical guidelines."

Some consumer advocacy groups and labor unions also have sought information on Medicare reimbursements to individual physicians. Debra Ness, president of the National Partnership for Women and Families, said, "Medicare and private health plans could save billions of dollars if just one in 10 beneficiaries moved from less efficient to more efficient physicians."

However, John Wennberg of Dartmouth Medical School said, "I would caution against simplistic efforts to measure efficiency. It's very difficult to get reliable data on cost and quality at the individual physician level" (Pear, New York Times, 4/11).