CMS mulls how to unseal Medicare doctor pay data

Washington Medicare policy on disclosing individual physician payment data has been reopened for debate in light of recent legal challenges and administrative efforts to provide greater transparency on health spending.

The Centers for Medicare & Medicaid Services is requesting comments on the potential release of payment information that could include the line-item details reported on claims for patient services, or aggregated data for individual physicians. The deadline for comment submissions is Sept. 5.

The Dept. of Health and Human Services created policy in 1980 that states “the public interest in the individually identified payment amounts is not sufficient to compel disclosure in view of the privacy interest of the physicians.” The question as to whether this sentiment has changed will be open for discussion.

CMS posted an Aug. 6 request for comments on that policy as part of the Obama administration effort to shed more light on Medicare billing. For example, the Medicare agency released hospital charge data for common procedures in May. Medicare officials at the time did not rule out expanding data releases to other parts of the program, including information reported by physicians on claims for patient services.

“CMS recognizes the potential for transforming the health care system that our data provides,” the agency stated on a blog post announcing the latest request for comments. “By making our charge information public, we can help promote initiatives that can reduce costs and improve quality. This is only the latest step CMS is taking to increase transparency, but it won’t be the last.”

Recent court ruling in play

On May 31, a federal judge vacated a 1979 injunction preventing the release of the physician information. Dow Jones & Co., the parent company of The Wall Street Journal, along with the consulting firm Real Time Medical Data filed a 2011 lawsuit that sought greater access to the Medicare data. The WSJ and other media outlets had obtained portions of data, but only under the condition that reporters were prohibited from naming individual physicians in published stories about Medicare spending. The newspaper had sought unrestricted access to raw Medicare data on physician pay to pursue possible stories about alleged fraud and abuse in the program.

The judge’s ruling did not grant unfettered access to the CMS data warehouse. The 1980 HHS policy still stands, but now the administration will revisit the question of whether the public should be able to access individually identifiable Medicare payment amounts.

The American Medical Association has supported policy that improves transparency, whether it be efforts that provide accurate health care information for patients or clinically relevant data to help physicians provide high-quality and efficient care, said AMA President Ardis Dee Hoven, MD.

“We are concerned that the public dissemination of raw Medicare claims data, which does not provide patients with helpful information on the quality of care or treatment options, can be misleading and in some cases harmful,” Dr. Hoven said. “The AMA will review CMS’ request for input and provide detailed comments to help ensure that improved transparency results in accurate information useful to both patients and physicians.”