CMS Modifies Policy on Disclosure of Physician Payment Information

By: Jonathan Blum, Principal Deputy Administrator

Today the Centers for Medicare & Medicaid Services (CMS) took a step forward in making Medicare data more transparent and accessible, while maintaining the privacy of beneficiaries.  Today’s Federal Register notice modifies the administration’s policy on disclosure of physician payment information.  Going forward, CMS will evaluate requests for individual physician payment information (or requests for information that combined with other publicly available information could be used to determine total Medicare payments to a physician) on a case-by-case basis.  The new policy released today will take effect 60 days after publication in the Federal Register. In addition, CMS will generate and make available aggregate data sets regarding Medicare physician services for public consumption.

In making the decision to replace the prior policy, the agency considered the more than 130 comments representing the views of over 300 organizations and individuals we received (http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/PublicComments.pdf).  Numerous of these comments identified ample benefits to releasing Medicare physician payment data, including use of the data by:

  • Providers to collaborate on improved care management and the delivery of healthcare at lower costs;
  • Consumers to gain broader, more reliable measures of provider quality and performance which drives innovation and competition while informing consumer choice; and
  • Journalists and others to identify waste, fraud, and abuse as well as unsafe practices.

The decision to modify the policy also takes into account HHS’ strong commitment to greater data transparency over the past several years.  In 2010, HHS launched the Health Data Initiative to promote transparent, innovative, and safe data use.  As part of this effort, CMS has engaged with a wide range of public, non-profit, and private sector stakeholders to foster the availability and use of health care data to drive innovations that improve health and health care. 

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.  However, CMS also recognizes the valid concerns raised by many stakeholders over protecting the integrity of the data.  As CMS makes a determination about how and when to disclose any information on a physician’s Medicare payment, we intend to consider the importance of protecting physicians’ privacy and ensuring the accuracy of any data released as well as appropriate protections to limit potential misuse of the information.  And as always, we are committed to protecting the privacy of Medicare beneficiaries.

This policy change follows other CMS efforts to make more data available to the public.  Since 2010, the agency has released an unprecedented amount of aggregated data in machine-readable form, with much of it available at www.healthdata.gov.  These data range from previously unpublished statistics on Medicare spending, utilization, and quality at the state, hospital referral region, and county level, to detailed information on the quality performance of hospitals, nursing homes, and other providers. 

In May 2013, CMS released information on the average charges for the 100 most common inpatient services at more than 3,000 hospitals nationwide http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html.

In June 2013, CMS released average charges for 30 selected outpatient procedures http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Outpatient.html.

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