CMS Makes Physician Claims Data Public

The federal Centers for Medicare & Medicaid Services released a potential treasure trove of 2012 Medicare physician claim information. The release, which makes the data public for the first time since 1979, is "a huge step to making the Medicare system more transparent," CMS says.

Early Wednesday morning, the federal Centers for Medicare & Medicaid Services released a potential treasure trove of 2012 Medicare physician claim information.

Hours later on a conference call with media, CMS officials presented a spirited defense for making the data public for the first time since 1979, when a US District Court issued an injunction that blocked its release due to privacy concerns. The injunction was lifted last May.

"CMS has taken another huge step to making the Medicare system more transparent," Principal Deputy Administrator Jonathan said. "For too long, this information was not made public."

He started with the contention that "the public has a right to know this information," which includes Medicare payment and utilization data for about 880,000 physicians nationwide. The total of the Medicare payments to physicians tallied in the 2012 data is about $77 billion.

Another factor Blum cited was wide variance in doctor payment data from state to state and within state borders. The release of the claims data will help stakeholders, patients, and the public "better understand the variation," he said. "We know there is waste in the system. We know there is fraud in the system."

Blum expressed hope that stakeholders, the press, and members of the general public would use the data in ways that will help contain healthcare costs and promote quality. "We are asking for the public's help," he said.

'We're Definitely Concerned'
The American Medical Association, which was a plaintiff in the federal court case that prompted the 1979 injunction, raised a slew of red flags Wednesday, unveiling a guide to help anyone mining the newly released Medicare claims data for insightful information.

In a statement issued simultaneously with CMS's release of the physician pay information, AMA President Ardis Dee Hoven, MD said her group was "disappointed that CMS did not include reasonable safeguards that would help the public understand the limitations of this data."

"We believe that the broad data dump today by CMS has significant shortcomings regarding the accuracy and value of the medical services rendered by physicians," Hoven said. "Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions, and other unintended consequences."

"Thoughtful observers concluded long ago that payments or costs were not the only metric to evaluate medical care. Quality, value and outcomes are critical yardsticks for patients. The information released by CMS will not allow patients or payers to draw meaningful conclusions about the value or quality of care."

Allison Brennan, senior advocacy advisor at the Medical Group Management Association, says that her group shares the AMA's concerns over unintended consequences flowing from release of the Medicare claims data.

"If people are drawing conclusions from this data… it's only representative of a portion of a physician's patient population," she said in a phone interview Wednesday. Brennan noted the physician claims data does not include millions of patients in Medicare Advantage health plans, Medicaid programs, or people who have healthcare coverage through commercial payers. "You have no way of knowing."

MGMA fears some doctors could suffer unfair harm to their reputations from the data release. "We're definitely concerned," she said.

Finding Common Ground
Earl Ferguson MD, PhD, a Ridgecrest, CA-based cardiologist and healthcare reform advocate, says CMS and physicians need to work together to release as much healthcare delivery information as possible.

"It's the right thing to do. The more information we have to make informed decisions the better," he said in a phone interview Wednesday. "There are probably a lot of physicians out there who don't want to see this information 'out there.' But I think it's necessary for the reforms to move forward."

Ferguson is also Medical Director of National Rural ACO, a firm that helps organizations change payment models. He acknowledges that some people will inevitably draw unfounded conclusions from the Medicare claims data. He believes, however, that the benefits of advancing transparency are significant and vital to creating a value-based healthcare delivery system.

"This is just one step," he says. "We need to have a lot more transparency in government and health plans. We can't keep everything secret if we're going to reform the system."

Ferguson has published a book about healthcare reform and says more cooperation and accountability will be decisive for transparency and other reform initiatives.

"You need to look at the data," he says. "We need to get all these people together and find out what is rational, rather than having bureaucrats and others making decisions for us… Things have been dictated to physicians and patients. We have to hold everybody accountable for doing what is correct and right. I don't see that happening enough."