The issue of whether physician reimbursement data should be made public is creating a split among doctors. Some argue that the public has a right to know how tax dollars are being spent. Others fear payment disclosures could hurt competition.
Despite the government's stated "strong commitment to greater transparency" in healthcare, whether doctors want to publicly divulge payments they receive from Medicare is questionable. That became clear recently when the American College of Physician Executives polled its members about whether they favored public disclosure of physician payments. Peter Angood, MD, the ACPE's CEO, thought, surely, they would vote to support openness.
But when asked last month if they thought data about Medicare payments to physicians should be made public, the response is almost evenly split, with 46% of responding members saying "no" and 42% saying "yes," according to an American College of Physicians Executives poll of 508 members. An additional 12% were unsure.
The results were not exactly the 60% to 70% that Angood thought might favor transparency. "I thought it would be a little more skewed" in the direction of transparency, Angood says.
The ACPE carried out its survey in the wake of court action and Center for Medicare & Medicaid Services' inquiries around the "transparency" issue about physician pay for possible rule-making that could change decades of federal policy that kept doc moneymaking under wraps.
James C. Salwitz, MD, from New Brunswick, NJ, who is concerned about the transparency question impact, tells me bluntly: "Physicians are going to have a heart attack, they are going to run from this. You are already seeing physicians pulling out from insurance, and they have reimbursement issues, and overwhelming hassles. The first time a physician sees a patient with a printout of how much the doc made, it will be the last Medicare patient he will ever see."
The transparency issue is explosive in the physician community as some groups, including health organizations and journalists, hunger for more data about payments made to physicians. CMS concedes it is asked plenty of questions about physician payment and reimbursement data, for "research, assessment, and evaluation of programs."
Many doctors believe transparency is important, arguing that the public has a right to know how their tax dollars are being spent, according to ACPE's poll of physicians. And some doctors believe that demand from consumers will intensify. It doesn't make sense to fight it, or give in to suspicions that they may have something to hide, these doctors say.
"We live in an information age," Daniel McDevitt, MD, FACS, from Atlanta, GA, wrote to ACPE. "We should be able to look up online where our money is going at all times."
The door was kicked open on the transparency question in May, when U.S. District Court Judge Marcia Morales Howard in Jacksonville, FL vacated the longstanding injunction, handed down in 1979, that had prevented CMS from releasing information about payments to individual physicians.
Years ago, the American Medical Association, among others, successfully petitioned the court to prohibit the government from disclosing the amount of taxpayer dollars that individual doctors receive from Medicare reimbursements. The injunction was embedded for so long, HHS was known as the Department of Health, Education, and Welfare (HEW) when it began.
"Over three decades ago, this court entered an injunction that still serves as a nationwide gag order, severely limiting access to essential information about one of the most important and expensive government programs, Medicare," Dow Jones, parent company of The Wall Street Journal, wrote in court papers opposing the injunction, before Federal Judge Howard made her decision.
The injunction "is now glaringly outdated based on legal and factual landscape that there's virtually no resemblance to in the present day," Dow Jones wrote. The Wall Street Journal sought increased public access to physician records that would help expose waste and abuse, noting its limited data availability in its series, "Secrets of the System."
Prompted by the court ruling, CMS is seeking feedback to determine what specific policies it should consider with respect to disclosure of individual payment data that will further the agency's goals of improving the quality and value of care. It also seeks to determine in what form the agency should release "information about individual physician payment, should CMS choose to release it."
"In light of this recent legal development and our ongoing commitment to greater transparency in the health care system, CMS is not considering public disclosure of any information that could directly or indirectly reveal patient-identifiable information," CMS has stated.
Still, for physicians unhappy with the move toward transparency, there are questions about the process and potential data collection. "If you are talking about individual doctors and pushing out line-item payments, it's hard to imagine it will do anybody any good," says Salwitz, the New Jersey physician.
For one thing, "the data is completely unintelligible and the overhead for physician practices [varies] massively," he says. In the long run, such disclosures could hurt smaller practices because larger practitioners and healthcare corporations would have access to data that could undermine competition, Salwitz says. It could even impact physicians in their private lives, for instance, when outsiders, such as realtors evaluate their earning power, he says.
Another physician, Kenneth Maxwell, MD, from Winston Salem, NC, wrote to ACPE: "What purpose does this action serve? Publishing the amount of Medicare reimbursement without some form of normative information provides no useful information for consumers.
Despite the split among the ACPE, Angood, the group's leader, believes that the overall move toward "greater transparency in medicine and increased public reporting" is necessary and here to stay.
The differences within his group show that government regulators need to "throw up a flag of caution" as they consider all the policy changes, Angood says. "Part of our job as physician leaders is to help ensure that when health care data is presented to the public, it is accurate, fair, meaningful and useful."
Angood may have been surprised by the nearly even vote in the poll results, but not the underlying reasons why.
It reflects the "degree of the sense of disenfranchisement many physicians have," Angood says. "And when any human starts to get disenfranchised, they begin to get suspicious about what motivates the external voices changing their environment."
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
