Does the Medicare payment transparency policy chip away at physician privacy?

Beginning this spring, it will be easier for insurance companies, patients, and watchdogs to get payment information about individual physicians due to a policy change by the Centers for Medicare and Medicaid Services (CMS).

According to a post on the CMS blog, the agency will evaluate requests for physician pay information in the same way as other Freedom of Information Act (FOIA) requests. CMS will also begin creating and publishing data sets of physician pay and services. These new rules go into effect 60 days after they are published in the 2014 Federal Register.

CMS states that the move is in response to more than 130 comments from more than 300 organizations about making payment data available. “Given the advantages of releasing information on Medicare payment to physicians and the agency’s commitment to data transparency, we believe replacing the prior policy with a new policy in which CMS will make case-by-case determinations is the best next step for the agency,” Jonathan Blum, principal deputy administrator for CMS, said in the blog post.

But opponents of the change argue that it will send the wrong message to the public and causes privacy issues for physicians.

“The disclosure of payment data from government health care programs must be balanced against the confidentiality and personal privacy interests of physicians and patients who may be unfairly impacted by disclosures,” says Ardis Dee Hoven, MD, president of the American Medical Association (AMA). “The unfettered release of raw data will result in inaccurate and misleading information. Because of this, the AMA strongly urges HHS [the U.S. Department of Health and Human Services] to ensure that physician payment information is released only for efforts aimed at improving the quality of health care services and with appropriate safeguards.”

It will be hard to predict how the release of this information will affect physicians, because it is still unknown how information requests will be processed, says Jennifer Gasperini, senior government affairs representative for the Medical Group Management Association. “We want transparency. But it’s tricky how some of the things that we use to measure it is not necessarily a proxy for quality,” Gasperini says.

Blum addressed physician privacy issues in the post, ensuring that each request for information would be evaluated on a “case-by-case basis.”

“As CMS makes a determination about how and when to disclose any information on a physician’s Medicare payment, we intend to consider the importance of protecting physicians’ privacy and ensuring the accuracy of any data released as well as appropriate protections to limit potential misuse of the information,” Blum said.

Medicare reimbursements won’t be the only physician payments visible to the public this year. The Physician Payments Sunshine Act, a provision of the Affordable Care Act, will require that drug and device manufacturers disclose any payments made to healthcare providers. The information will be made public at the end of September.

CMS’ recent efforts at transparency with the public include releasing information about the 100 most common inpatient services in May 2013 and average charges for the top 30 outpatient procedures in June 2013.