Medi­care data re­lease on doc pay­ments to bring new trans­parency era

Modern Healthcare - - THE WEEK AHEAD - —Joe Carl­son

Many physi­cians will be wait­ing with trep­i­da­tion as the CMS pre­pares to re­lease, as early as Wed­nes­day, a data base de­tail­ing what Medi­care paid to all par­tic­i­pat­ing doc­tors in 2012.

The CMS will pub­lish physi­cian-spe­cific data on $77 bil­lion in pay­ments to 880,000 physi­cians through Medi­care’s Part B physi­cian pro­gram. The in­for­ma­tion is sup­posed to show the num­ber and type of ser­vices pro­vided by each physi­cian, how much the doc­tor billed for, and the amount that he or she was ac­tu­ally paid.

Physi­cian groups long have re­sisted re­lease of this in­for­ma­tion, and the CMS only re­cently took the po­si­tion that it had the author­ity to dis­close it. The agency orig­i­nally said it would re­lease the data only in re­sponse to Free­dom of In­for­ma­tion Act re­quests, but last week said it would broadly re­lease the in­for­ma­tion.

Ad­vo­cates for trans­parency in health­care prices, qual­ity, and uti­liza­tion say the data could re­veal pat­terns of waste­ful and fraud­u­lent ser­vices and billing and help curb Medi­care spend­ing. Physi­cians’ groups say the in­for­ma­tion is bound to be mis­in­ter­preted.

The 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,” said Dr. Ardis Dee Hoven, pres­i­dent of the Amer­i­can Med­i­cal As­so­ci­a­tion. “We have wit­nessed these in­ac­cu­ra­cies in the past.”

But some say the data re­lease could work to physi­cians’ ad­van­tage. For­mer AMA Sci­ence and Pub­lic Health Coun­cil chair­man Dr. Melvyn Ster­ling, a pal­lia­tive-care physi­cian from Or­ange, Calif., said the data may high­light that Medi­care rates haven’t kept pace with in­fla­tion and that doc­tors need a raise.


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