CMS to Disclose How Much It Pays Physicians

Tony Berberabe, MPH @OncBiz_Wiz
Published: Friday, Jan 17, 2014

The Centers for Medicare & Medicaid Services (CMS) will make public a once previously confidential database of Medicare claims. The move could potentially allow patients to find out how much Medicare paid their physicians and lead to closer scrutiny of what physicians charge for their services.

The change in policy comes as a result of a federal judge’s decision to end a 1979 injunction, which argued that physicians’ right to privacy outweighed the public’s interest in how much tax dollars were spent by Medicare. That injunction ruled in favor of the American Medical Association.

In 2011, Dow Jones & Co., the parent company of The Wall Street Journal, successfully challenged that injunction, showing how the information could be used to expose fraud and abuse within Medicare. On January 10, U.S. District Judge Marcia Morales Howard sided with Dow Jones, stating that case law narrowed the scope of the Privacy Act over the past 30 years and no longer warranted a broad injunction, as reported by the WSJ.

In his blog entry, Jonathan Blum, Principal Deputy Administrator at CMS, wrote that going forward, “CMS will evaluate requests for individual physician payment information (or requests for information that, combined with other publicly available information, could be used to determine total Medicare payments to a physician) on a case-by-case basis.” Requests would need to be filed under the Freedom of Information Act.

Blum described how releasing the data could benefit the public:

  • It could be used by providers to collaborate on improved care management and delivery of health care at lower costs
  • Patients could gain broader and more reliable measures of provider quality and performance
  • The media could identify waste, fraud, abuse, and unsafe medical practices
The new policy will take effect 60 days after its publication in the Federal Register, which was on January 15.

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