Release of Medicare Physician Payment Data Imminent

With the blessing of a federal judge, CMS is releasing Medicare data on physicians, including types of services, average submitted charges, and standard deviation in submitted charges.

The federal government's shift toward healthcare data transparency continues.

Centers for Medicare & Medicaid Services officials are planning to release payment and other Medicare data on 880,000 physicians across the country as soon as Wednesday, April 9. A federal court injunction had kept the data under wraps since 1979, but a US District Court ruling in Florida last spring lifted the injunction.

In May, CMS made public chargemaster data for the 100 most common Medicare inpatient diagnosis-related group (DRGs).

"CMS plans to publicly release a data set on the types of medical services and procedures furnished by physicians and other healthcare professionals as well as certain payment and charge data related to those services," Jonathan Blum, principal deputy administrator of CMS, says in a letter sent April 2 to the American Medical Association and the Florida Medical Association.

Both physician organizations that were parties in last spring's District Court case, a CMS official wrote that making the data public would help the drive to create a value-based US healthcare delivery system.

"This public data set will include number of services, average submitted charges and standard deviation in submitted charges, average allowed amount and standard deviation in allowed amount, average Medicare payment and standard deviation in Medicare payment, and a count of unique beneficiaries treated."

In the letter, Blum, also made the claim that release of the data is required under the Freedom of Information Act.

AMA President Ardis Dee Hoven MD wasted no time responding to the CMS letter, issuing a statement on April 2 that is highly critical of the forthcoming release of the Medicare data.

"The AMA is concerned that 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. We have witnessed these inaccuracies in the past," Hoven wrote. "To guarantee that information is accurate, complete, and helpful, the AMA strongly recommends that physicians be permitted to review and correct their information prior to the data release."

On the same day Blum sent his letter to the AMA and the FMA, he also wrote about the release of the Medicare data in a post on the CMS blog. He contends that release of the Medicare data will help achieve several goals including greater transparency in medical services.

"This data contains information on more than 880,000 health care professionals in all 50 states who collectively received $77 billion in payments in 2012 for services delivered to beneficiaries under the Medicare Part B Fee-For-Service program. With this data, it will be possible to conduct a wide range of analyses that compare 6,000 different types of services and procedures provided, as well as payments received by individual health care providers," Blum wrote.

Legal Battle Over Injunction
In a US District Court ruling last spring, Judge Marcia Morales Howard wrote that the AMA and FMA had made three arguments against lifting the 1979 injunction:

• Neither the facts nor the law had changed since 1979
• The revenues that individual physicians receive for their services to Medicare patients continue to be private information
• The public interest in preventing Medicare fraud had not changed since 1979

In a decision that proved crucial in the lifting of the 1979 injunction, Howard ruled that applicable federal law had changed significantly over the past three decades.

In the April 2 letter, Blum said CMS had considered physician privacy when deciding whether to fight release of the Medicare data. "The Department weighed the privacy interests of physicians and the public's interest in shedding light on Government activities and operations and has determined that the public's interest outweighs the privacy interests," Blum wrote.

'The Right Thing to Do'
Jennifer Schneider MD, vice president of analytics at San Francisco-based Castlight Health, says there is a simple and compelling reason to release the Medicare physician data. "It's the right thing to do," she said in a phone interview Tuesday.

Castlight specializes in selling healthcare information services to self-insured employers to help businesses provide affordable health insurance options to their workers. The firm was founded in 2008 "to tackle one of healthcare's fundamental problems—the lack of transparency in the price and quality of health care," according to the company's web site.

In addition to changes in federal law that cleared the way for Judge Howard to lift the 1979 injunction against releasing the Medicare data, there have been major changes in US healthcare that make the data a potential gold mine for reform advocates, Schneider said. "The costs-per-head for healthcare have risen dramatically," she said. "The costs have risen higher than the income level."

Schneider says releasing Medicare data will shine light on differences in physician fees that will expose doctors who are not delivering good value to their patients. "The price variance" among many medical procedures "is between three- and 10-fold," she says.

Knowing the types and volume of procedures physicians perform will be particularly useful to patients, Schneider said. Knowing the types of procedures a physician performs indicates areas of expertise and procedure volume is a well-established metric for gauging medical outcomes.

Combining Medicare physician data with other sets of information such as commercial claims and quality data has the potential to accelerate efforts to create a value-based US healthcare delivery system, Schneider says. "The release of this information and the overlay of other information… becomes really powerful."