By Mindy Yochelson
Feb. 11 --With an effective date about a month away, some doctor groups are
cautious about how a new Centers for Medicare & Medicaid Services policy on
the release of Medicare payment data will impact members.
“We'll have to
wait to see how CMS uses this new authority,” Reid Blackwelder, president of
the American Academy of Family Physicians, told Bloomberg BNA. “Our hope is
that researchers use this data to understand and improve how health care
dollars are spent.”
In a Jan. 17 notice, the CMS said it would begin to institute a new
policy for releasing data on how much Medicare is reimbursing individual
doctors (79 Fed. Reg. 3,205) . The agency said it will make individual
determinations under the Freedom of Information Act (FOIA), weighing the
privacy interest of the individual against the public interest.
Under its “Modified Policy on Freedom of Information
Act Disclosure of Amounts Paid to Individual Physicians Under the Medicare
Program,” which takes effect March 18, the CMS said it would use a FOIA
exemption when it receives such a request (25 MCR 69, 1/17/14).
previous policy, which had been based on court orders, was that the public
interest was insufficient under FOIA to allow the disclosure of amounts that
Medicare pays to individual physicians.
The CMS was legally barred from
disclosing identifiable annual Medicare reimbursement payments of individual
physicians or disclosure of payments in a manner that could identify individual
The new policy, delivered in a short notice sparse of
operational detail, said the agency will start making case-by-case
determinations as to whether FOIA's “exemption 6” applies to a given request
for information. Exemption 6 requires CMS to weigh the balance between the
privacy interest of individual physicians and the public interest in disclosure
of such information.
“As the outcome of the balancing test will depend
on the circumstances, the outcomes of these analyses may vary depending on the
facts of each case,” the CMS said.
M. Gilberg, senior vice president of government affairs at the Medical Group
Management Association, called the notice “ambiguous” and said the CMS failed
to make clear the standards it will use to evaluate data requests.
has always supported the release of meaningful cost and quality data to benefit
Medicare beneficiaries, but using an exemption in FOIA to release raw claims
data without clear safeguards raises privacy concerns and may lead to its
misuse,” he told Bloomberg BNA.
American Medical Association President
Ardis Dee Hoven, in a statement, urged that physician payment information be
released only for efforts aimed at improving the quality of health care
services and with appropriate safeguards.
Both doctors and patients
could be “unfairly impacted,” she said, by “the unfettered release of raw data”
which could “result in inaccurate and misleading information.” She added that
“the disclosure of payment data from government health care programs must be
balanced against the confidentiality and personal privacy interests of
physicians and patients.”
The data release
saga reached a turning point in May 2013 when a federal court vacated a
33-year-old injunction that had foreclosed the government from releasing any
Medicare physician reimbursement data that would identify specific physicians
(24 MCR 669, 6/7/13).
The CMS subsequently asked for public comment
about developing a new policy, stating that it has been receiving “multiple
requests from various stakeholders for physician payment and reimbursement
The agency had said it recognizes the role data can play in
“achieving the common goal of better quality health care at lower costs.”
In one of the comments, about 80 state and national medical groups offered
the operational details and protections they wanted to see in a new policy.
“Given the potential for security breaches, hackers, or efforts to
re-identify information, we urge CMS to consider the potential impact of any
data release on patient privacy and engage with experienced data statisticians,
physician organizations, and other relevant stakeholders on ways to further
protect such data,” according to one of the points in the five-page letter.
The signatories said they supported efforts that increase knowledge about
the quality of care and the efficient use of resources, but also warned against
allowing “untrained entities that lack knowledge about the Medicare program to
attempt to detect fraud and abuse.”
In addition, “raw Medicare claims
data is a crude metric for assessing the quality of medical care,” they said.
“When used in isolation this data ignores the more important clinical factors
that affect patients, including case mix, co-morbidities, and other patient
cautious, Blackwelder was optimistic about the new policy.
correctly, the data can provide accurate and meaningful information to
patients, physicians, and other stakeholders that can improve quality at the
point of care,” he said. For example, it could be used to track billing for
certain preventive services such as flu vaccinations.
The AAFP president
said that CMS's new policy is not a “wholesale, cookie-cutter approach to
releasing data and will weigh the privacy interests of individual physicians
with the public interest in disclosure of payment information.”
he continued, it “ensures that CMS will evaluate each request rather than
establish a universal protocol that risks inappropriate release of data.”
To contact the reporter on this story: Mindy Yochelson in
Washington at firstname.lastname@example.org
To contact the editor
responsible for this story: Ward Pimley at email@example.com
The CMS January notice
is at http://www.gpo.gov/fdsys/pkg/FR-2014-01-17/pdf/2014-00808.pdf.
To view additional stories from Medicare Report register for a free trial now