SGR Bill's Payment Transparency Provision Elicits Concern

At least two physicians groups are expressing concern about a provision to a Senate bill that would repeal the Sustainable Growth Rate formula. The provision calls for the creation of a database that would include all payments made to physicians by Medicare.

Almost lost in the brouhaha over the expected repeal of the Sustainable Growth Rate funding formula is a provision that would make a physicians' Medicare claims database available to the public online and at no cost.

House and Senate versions of the "doc fix" bill repealing the SGR include language from the Medicare Data Access for Transparency and Accountability Act (Medicare DATA Act), legislation sponsored by Sens. Chuck Grassley, (R-IA), and Ron Wyden, (D-OR).

The database would include all payments made to physicians by Medicare. Patients' privacy would be fully protected, and providers would have an opportunity to correct payment information before being posted online. Currently, access to the Medicare payment database is limited to government officials and academics despite a federal judge's ruling in favor of greater public access, Grassley and Wyden said in a joint media release.

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"Transparency draws in the public and invites analysis of policy and spending," Grassley said. "More transparency has made a difference in accountability in the tax-exempt sector, and it does the same wherever it's applied in healthcare."

If the language is not stripped from the budget, the transparency provisions for physicians would take effect on July 1, 2015, and on July 1, 2016 for other healthcare professionals.

The transparency language was greeted with caution by the physicians' lobby. American Medical Association President Ardis Dee Hoven, MD, lauded the demise of the SGR, but offered guarded praise for the transparency provisions.

"With certain safeguards, the AMA supports expanding physician access to Medicare claims data from Qualified Entities and qualified clinical data registries to support quality improvement activities," Hoven said in prepared remarks.

"The AMA has concerns about requiring the Department of Health and Human Services to publicly release raw Medicare physician claims data without similar safeguards as currently applied to QEs. These safeguards include appropriate attribution and risk adjustment, timely correction of errors with appeal rights, and explanatory information to best inform patients."

Shari M. Erickson, vice president, Governmental and Regulatory Affairs, American College of Physicians, says the college shares the AMA's concerns.

"In general we are supportive of having transparency of quality and pricing information. It is useful for a wide range of stakeholders. It can help patients and their families make important decision," Erickson says. "But it has to be paired with transparency in the process – how that information is calculated and how it is reported out, and there needs to be appeal mechanisms in place."

"It will be challenging because it is a bit confusing when you get into prices and charges and costs," Erickson says. "They all mean slightly different things in the healthcare system. Something may have one price but the actual charge is a little different based on what your health plan charges and what folks pay out of pocket may be even different still given co-pays and coinsurance, etc."

The American College of Surgeons issued a statement on December 10 supporting a repeal effort, but opposing "the current Senate Finance and House Ways and Means Committees' proposal, because it calls for a 10-year physician payment freeze and provides inadequate incentives for providing value-based care."

Lawmakers have until March to repeal or fix the SGR.