CMS to release individual Medicare physician payment data

As early as next week, the Centers for Medicare and Medicaid Services plans to release data on what it pays doctors at the individual physician level, a move long opposed by physician groups such as the American Medical Association (AMA).

In letters to the AMA and the Florida Medical Association, CMS’s Principal Deputy Administrator Jonathan Blum explains how the number of requests the agency has received for individual physician payment data under the Freedom of Information Act since March 18 has made it incumbent upon CMS to release some of this data to the general public on its website. (That policy change was due to a federal judge in May lifting the 33-year-old injunction that prevented the government from allowing the public to access its database of Medicare insurance claims.)

The data set to be released sometime after April 9 covers the 2012 claims period. It will include the types of medical services and procedures furnished by physicians and other healthcare professionals organized by National Provider Identifier (NPI) code, Healthcare Common Procedure Coding System (HCPCS) code, and whether the service was furnished in a facility or office setting. In addition, it will include certain payment and charge data related to those services, such as:

• average submitted charges
• standard deviation in submitted charges
• average allowed amount
• standard deviation in allowed amount
• average Medicare payment
• standard deviation in Medicare payment

It was unclear from the letter how the data release would affect physicians that submit claims as part of a medical groups with a single NPI.

In an accompanying CMS blog post, Blum noted that the release of this data builds on last year’s release of individual payment data for hospitals. That data set led to numerous articles about the disparities in hospital costs in the mainstream media and heightened the national debate over the factors driving high healthcare costs.

Senators Charles Grassley (R-Iowa) and Ron Wyden (D-Ore.) were quick to praise the plans to release the data. Earlier this year, they introduced the bi-partisan Medicare Data Access for Transparency and Accountability Act (S. 1180), which would have forced CMS to release exactly this type of Medicare claims data to the public.

“Transparency draws in the public and invites analysis of policy and spending,” Sen. Grassley said in a statement. “More transparency has made a difference in accountability in the tax-exempt sector, and it does the same wherever it’s applied in health care. The public’s business ought to be public. I’m looking forward to the positive effects on accountability and spending from the new transparency in Medicare.”

“Transparency is key to improving care for patients and creating greater efficiencies in health care,” Sen. Wyden added. “Today’s announcement is a huge step forward for Medicare enrollees, who should be able to compare doctors, hospitals and clinics on the basis of quality and price.”

But the AMA and other have raised serious concerns about the release of the data, particularly as not all of it may be accurate and individual physicians currently have no way of quickly getting inaccuracies in the data set corrected. The AMA would like CMS to let physicians review and correct the data before it is released to protect practices and individual reputations.

“CMS' broad approach to releasing physician payment data will mislead the public into making inappropriate and potentially harmful treatment decisions and will result in unwarranted bias against physicians that can destroy careers," the AMA warned in a statement according to Modern Healthcare.