CMS To Begin To Release Medicare Physician Payment Data
On Tuesday, HHS published a notice in the Federal Register that CMS will begin to respond to Freedom of Information Act requests for Medicare physician payment data, Modern Healthcare reports (Carlson, Modern Healthcare, 1/14).
In May 2013, a federal judge lifted a 33-year-old injunction that barred the government from giving the public access to a confidential database of Medicare insurance claims.
The court injunction stemmed from a lawsuit that the American Medical Association and the Florida Medical Association filed to prevent former President Jimmy Carter's administration from publishing a list of annual Medicare reimbursements.
The database, known as the Carrier Standard Analytic File, contains information on physicians and other health care providers participating in Medicare who are paid on a fee-for-service basis. It incorporates all physician claims that Medicare paid directly.
Federal investigators can use the database to identify fraud, but its information on physicians and other individual providers had been kept confidential from the public.
In August 2013, CMS asked for public comments on whether physicians have a privacy interest regarding their Medicare reimbursements (iHealthBeat, 11/4/13).
Details of New Policy
According to a CMS blog post, the agency considered more than 130 comments representing more than 300 organizations and individuals before revising its policy.
In the blog post, CMS Principal Deputy Administrator Jonathan Blum wrote, "Given the advantages of releasing information on Medicare payment to physicians and the agency's commitment to data transparency, we believe replacing the prior policy with a new policy in which CMS will make case-by-case determinations is the best next step for the agency" (Blum, CMS blog post, 1/14).
However, some information still might be withheld from the public under FOIA's privacy exemption if the damage to physician privacy is deemed greater than the public interest in the information, according to Modern Healthcare.
The Federal Register notice states, "As the outcome of the balancing test will depend on the circumstances, the outcomes of these analyses may vary depending on the facts of each case." It adds, "However, in all cases, we are committed to protecting the privacy of Medicare beneficiaries."
HHS' new policy on disclosing Medicare physician payment data will take effect 60 days after it was published in the Federal Register. In addition, CMS will begin publishing aggregate data sets on Medicare physician services.
American Medical Association President Ardis Dee Hoven said that "the disclosure of payment data from government health care programs must be balanced against the confidentiality and personal privacy interests of physicians and patients who may be unfairly impacted by disclosures." She added, "AMA strongly urges HHS to ensure that physician payment information is released only for efforts aimed at improving the quality of health care services and with appropriate safeguards."
However, other stakeholders said the new policy does not go far enough to improve health data transparency.
Joel White, president of the Council for Affordable Health Coverage, said, "Ideally and ultimately, HHS should disseminate the information via a publicly accessible database rather than on a case-by-case basis," adding, "These data have a value too great in reducing costs, curtailing fraud and improving quality to be handled on an ad hoc basis" (Modern Healthcare, 1/14).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.