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CMS Makes Physician Claims Data Public

Christopher Cheney, for HealthLeaders Media, April 10, 2014

The federal Centers for Medicare & Medicaid Services released a potential treasure trove of 2012 Medicare physician claim information. The release, which makes the data public for the first time since 1979, is "a huge step to making the Medicare system more transparent," CMS says.

Early Wednesday morning, the federal Centers for Medicare & Medicaid Services released a potential treasure trove of 2012 Medicare physician claim information.

Hours later on a conference call with media, CMS officials presented a spirited defense for making the data public for the first time since 1979, when a US District Court issued an injunction that blocked its release due to privacy concerns. The injunction was lifted last May.

"CMS has taken another huge step to making the Medicare system more transparent," Principal Deputy Administrator Jonathan said. "For too long, this information was not made public."

He started with the contention that "the public has a right to know this information," which includes Medicare payment and utilization data for about 880,000 physicians nationwide. The total of the Medicare payments to physicians tallied in the 2012 data is about $77 billion.

Another factor Blum cited was wide variance in doctor payment data from state to state and within state borders. The release of the claims data will help stakeholders, patients, and the public "better understand the variation," he said. "We know there is waste in the system. We know there is fraud in the system."

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1 comments on "CMS Makes Physician Claims Data Public"


Russell Libby, MD (4/15/2014 at 11:14 AM)
I think the release of Medicare physician payment data is not of great significance and will not change what has been the honest and sincere efforts to provide good care at Medicare rates by the vast majority of physicians who see these patients. Most patients feel good about the value of the care they receive and do not have a negative perception of their physician or begrudge them for what they charge. It is unfortunate if the spin on this information tries to make it look like something else; Medicare is not a great payer and the regulatory impositions are already unwieldy. In fact, patients typically already see what a physician charges their insurance company when they receive their explanation of benefits. They also see what fraction of that charge they get paid for, which is not, evidently, broken down for them in the Medicare data. This kind of expose is not going to go away nor is it it going to deter public perception by defending ourselves. What has floated this to the surface is that small number of doctors who have been defrauding Medicare over the years and make big headlines when they are identified. What is not pointed out, of course, is that Medicare is not a great payer and that the vast majority of physicians are providing a service to society by taking care of a complex and often expensive segment of our population at what are actually low payment rates that hardly cover overhead and rarely make someone rich. Transparency is a good thing, but what is most important is that it not be presented in ways that can be skewed, confuse the public, and inappropriately impugn a physician. The recently implemented Sunshine Act is another element of potential confusion that the government can create for physicians. It may be standards that our legislators and regulators need to apply to themselves.