CMS to Release Physician Payment Data

Physicians' associations generally support improving access and transparency in Medicare reimbursement records within the proper context and with privacy protections, but caution that "you can't always use this data as a proxy for quality."

The federal government has issued a new policy for public disclosure of physicians' Medicare payments.

Jonathan Blum, principal deputy administrator for the Centers for Medicare & Medicaid Services said in a statement posted Tuesday by CMS that the modifications, posted in the Federal Register, will improve transparency and accessibility for the public while maintaining the privacy of Medicare beneficiaries.

The policy takes effect 60 days after its publication in the registry, which is expected this week. Blum says CMS will evaluate requests for individual physician payment information or requests for information that combined with other publicly available information that could be used to determine total Medicare payments to a physician on a case-by-case basis.

CMS will also generate and make available aggregate data sets regarding Medicare physician services for public inspection.

"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 wrote.

"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."

Physicians' Reactions
Representatives from physicians' associations said Tuesday they were still reviewing the new policy, but that they generally support improving access and transparency in Medicare records as long as the data is placed in its proper context.

Reid B. Blackwelder, MD, president of the American Academy of Family Physicians, says the his organization has been involved in the comment process for the modifications and continues to support the move towards greater transparency in medical records and billing.

"There can be a lot of value in releasing payment data, especially if it is focused on ensuring and improving quality of care," Blackwelder says. "The key continues to be the correct use. The trouble with data is [that] it's numbers. We emphasized the real need to ensure appropriate context. We want to make sure they just don't release numbers because you can get a lot of assessments or conclusions drawn that may not be true unless you have appropriate context and consideration."

Shari Erickson , vice president of governmental and regulatory affairs at the American College of Physicians, says the college also embraces "the move towards more data transparency overall in the healthcare system. That is going to be needed particularly as we move into this bold new world of value-base payments. You really are going to need more transparency to do that effectively."

Like Blackwelder, however, Erickson says putting the data in its proper context is critical. " There are definitely some protections and caveats that should be looked at with any data source that is being reported on, " she says.

Pay Data Not 'A Proxy for Quality'
"There should be reasonable transparency around the process of the data collection and reporting of that data so we know where the data comes from and what it means and what are its limitations. All of those things need to be up front anytime data is reported to the public. It needs to be reported in a meaningful and hopefully useful way for the public and the audiences that it is intended for."

Jennifer Gasperini, senior government affairs representative for the Medical Group Management Association, says everyone wants transparency. "The trickier issue is how we are measuring some of these things," she says. "For that reason you can't always use this data as a proxy for quality. It is something we will be looking at and continuing to watch."

Blackwelder says he doesn't believe the rules modifications will have much of an effect on the day-to-day operations of most physicians' offices. "We feel very strongly that with any release of data that the physician has an opportunity to review and ensure that the data is correct. Otherwise there isn't going to be anything a physician is going to notice in day-to-day practice," he says.