CMS To Release Physician Medicare Billing Data
By Dr. James Palermo // April 5, 2014
BEWARE, RELEASED DATA NOT A MEASURE OF QUALITY
Very soon, you’ll be able to log onto a government website that will provide information about the number and type of health care services that individual physicians and certain other health care professionals delivered in 2012, and the amount Medicare paid them for those services.
Earlier this week, in the CMS (Centers for Medicare and Medicaid Services) Blog, CMS Deputy Administrator Jonathan Blum reports that they planned to release the information as early as next week.
The public release of this information, a move that has faced fierce opposition from physicians’ groups for decades, will include data 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.
According to Blum, the information will give consumers an unprecedented look at how personal physicians stack up compared to others in order to get the best value for their health care dollar, and allow data analysts to spotlight doctors with suspicious billing patterns in an increasing effort to uncover Medicare fraud.
INFORMATION RELEASE STRONGLY OPPOSED BY AMA AND FMA
The American Medial Association (AMA) has strongly protested the release of any Medicare payment data that identifies individual doctors, based on the premise that it would be a violation of physicians’ personal privacy rights.
It was the AMA and the Florida Medical Association (FMA) that successfully convinced a federal judge in Jacksonville, Fla. in 1979 to permanently bar Medicare from publishing the data because of privacy concerns. However, the Florida injunction barring release of the data was overturned in 2013 by another Jacksonville judge, clearing the way for CMS to move forward with the information release.
In an April 2 letter to the AMA, Blum wrote, “Release of physician-identifiable payment information will serve a significant public interest by increasing transparency of Medicare payments to physicians … and shed light on Medicare fraud, waste and abuse.”
INFORMATION OUT OF CONTEXT MAY, MISLEAD PATIENTS, HARM DOCTORS
The AMA and other physician groups are concerned that the information won’t be placed in proper context and could damage the reputation of certain doctors.
In a statement issued Tuesday, AMA President Dr. Ardis Dee Hoven expressed concern “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.”
For example, Medicare payment for services in different cities and regions of the country varies, and many people viewing the information may not be aware of this.
Demographics are also a consideration. Some doctors, such as those in Florida where there is a very high retired population, may see a higher number of Medicare patients, resulting in more billings to the program than in other geographic areas of the country.
Also, the complexity of certain patients and extenuating clinical circumstances may cause some doctors to have much higher Medicare charges than others.
To guarantee that information is accurate, complete, and helpful, the association is asking the agency to allow physicians to review and correct their information before the database is released.
However, it is highly unlikely that CMS will comply with the AMA’s request to delay the release of information, which includes physicians’ provider IDs, their charges, their patient volumes and what Medicare actually paid.
VOLUME, COST DATA NO PROXY FOR QUALITY
Although data like these can help consumers compare the volume of services provided and payments received by individual health care providers, it’s important for consumer’s to be aware that quality reporting websites, of which there are many, will have access to the payment data and may incorporate them into their quality algorithms. Consumers should beware of this because this type of information should not be construed as a proxy for quality.