CMS is asking for public input on whether or not physicians have a privacy interest with their Medicare payments. If they do, CMS says it wants to create a review system that balances a physician's privacy with the public interest.
Now that Medicare payment data for individual physicians is no longer sealed from public view, the Centers for Medicare & Medicaid Services wants help building appropriate policies that balance transparency and access to the data with privacy protections for physicians.
A federal judge in May lifted an injunction in place since 1979 that prohibited CMS from disclosing Medicare payments to physicians. The ruling overturns a policy to protect physicians' privacy, which federal officials had installed at the behest of the American Medical Association.
"In light of this recent legal development and our ongoing commitment to greater transparency in the health care system, CMS seeks public input on the most appropriate policies with respect to disclosure of individual physician payment data," the agency said in an Aug. 6 request-for-public-comment notice.
Currently when the news media or other outside parties request annual Medicare payment data on individual physicians, CMS responds that it will have to provide the data under the Freedom of Information Act unless an exemption applies.
"In this case, since physician information is covered by the Privacy Act, we look at whether such disclosure may constitute a clearly unwarranted invasion of personal privacy by weighing whether the public interest in disclosure outweighs the physician's privacy interest in the information," CMS said.
"It is important to note that CMS is not considering public disclosure of any information that could directly or indirectly reveal patient-identifiable information. CMS is committed to protecting the privacy of Medicare beneficiaries."
CMS noted that the move toward greater transparency has gained considerable momentum in the 33 years since the injunction was put in place, driven by the substantial growth in the size of Medicare both in total cost and as a portion of the federal budget, and by public outcry over the fraud, abuse and waste in the program.
In addition, the Affordable Care Act allows CMS to provide Medicare claims data to some entities for the production of publicly available performance reviews.
"Since 2010, CMS has released an unprecedented amount of aggregated data in machine-readable form," CMS said. "These data range from previously unpublished statistics on Medicare spending, utilization, and quality at the state, hospital referral region, and county level, to detailed information on the quality performance of hospitals, nursing homes, and other providers.
In May 2013, CMS released information on the average charges for the 100 most common inpatient services at more than 3,000 hospitals nationwide, followed in June with the release of average charges for 30 selected outpatient procedures."
In its request-for-comment notice, CMS is asking for public input on whether or not physicians have a privacy interest with their Medicare payments. If they do, CMS says it wants to create a review system that balances a physician's privacy with the public interest.
CMS also wants suggestions on specific policies it should consider regarding the disclosure of individual physician payment data "that will further the goals of improving the quality and value of care, enhancing access and availability of CMS data, increasing transparency in government, and reducing fraud, waste, and abuse within CMS programs."
CMS also wants suggestions for how it should release information about individual physician payments, such as through line item claims details, or aggregated data at the individual physician level.
Remarks must be submitted within 30 days of the Aug. 6 notice.
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CMS Releases Hospital Pricing Data
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.