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Medicare payment data could be ‘misleading,’ say physician advocates


In a continued effort to boost transparency, CMS will release finalized Medicare payment data for more than 880,000 healthcare professionals, as early as April 9.

In a continued effort to boost transparency, the Centers for Medicare and Medicaid Services (CMS) has released finalized Medicare payment data for more than 880,000 healthcare professionals.

The data details the $77 billion that physicians received in 2012 from Medicare Part B payments for 6,000 different services and procedures. Provider PIN numbers and place of employment are included in the data sets. Patient information is not included.

The goal of the program is to help patients make informed choices about the care they receive, said Jonathan Blum, CMS principal deputy administrator, in a blog post.

“Data like these can shine a light on how care is delivered in the Medicare program,” Blum said. “They can help consumers compare the services provided and payments received by individual health care providers. Businesses and consumers alike can use these data to drive decision-making and reward quality, cost-effective care. We look forward to describing how this information can inform consumers and health care providers when we release this data in the near future.”

In January, CMS considered requiring Freedom of Information Act requests to disseminate physician payment information after a Florida ruling that allowed it to be public. After receiving multiple requests, CMS decided to release the information in raw data sets on its website. CMS expects to release the payment information annually at the same time next year.

“This will not be patient friendly or doctor friendly information. This is for organizations who will need to download files and then make sense of them,” says Neil Kirschner, PhD, senior associate for health policy and regulatory affairs for the American College of Physicians (ACP). He adds that ACP is in favor of CMS being more transparent, but the information presented without context could be misleading.

“The concern that people in the medical community have is how will this information be used. Depending on the organization reporting on the information, it might be misinterpreted,” Kirschner says.

Earlier criticism from the American Medical Association (AMA) echoes ACP’s concern.

“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,” AMA President Ardis Dee Hoven, MD, said in a written statement in February. “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 healthcare services and with appropriate safeguards.”

Next: Other payments to physicians will be made public


Last year, CMS released Medicare payment information for more than 3,000 hospitals, revealing significant price discrepancies for common procedures.

Other payments to physicians will also be made public this year. The Physician Payment Sunshine Act, a provision of the Affordable Care Act, will require pharmaceutical companies and medical device manufacturers to disclose to CMS any payments made to physicians. However, physicians will have an opportunity to review and correct any inaccuracies to that data before it is made public.



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Jennifer N. Lee, MD, FAAFP
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