Tuesday, February 17, 2015

Medicare Releasing Physician Claims Payment Data?

According to Yale's Robert Steinbrook, it is likely that at least some of U.S. physicians' Medicare data will become public.  In other words, a major percentage of physician incomes will become accessible to patients, insurers and provider organizations.

As the Disease Management Care Blog understands it, the Wall Street Journal successfully challenged a long-standing Medicare payment privacy rule in the course of its investigation into Medicare fraud.  As a result, CMS was forced to issue new rules on the release of Medicare payment data.  The details are fuzzy, but CMS promises to balance the competing needs for transparency and privacy, and respond to requests on a "case-by-case" basis. 

It is highly likely that at least some of those requests will be approved.

While the "transparency-means-value" advocates may rejoice, the DMCB isn't too sure. Physicians distrust first generation versions of public data reporting, and most simply ignore it.  Once the data become more meaningful, however, the upside in quality improvement has to be balanced by the downside of gaming with unintended consequences

As a result, when physicians are deciding whether to hospitalize, recommend surgery or arrange a consultation, they may end up wondering how that will make them "look" when their charge data go public.

U.S. physicians' relationship with Medicare is going to get a lot more interesting.

Two additional DMCB thoughts:

No one is demanding that the commercial insurers release their claims data to the public. While the rules governing the use of taxpayer dollars are different, the Wall Street Journal would have never gotten this far if Medicare had taken a page out of the commercial insurance playbook and using the data to identify fraudulent billing patterns in the first place. 

Recall that the Sunshine Act also requires the public disclosure of the financial relationships between physicians and pharmaceutical as well as medical device manufacturers.  While the intent of the Act is to identify conflicts of interest, it probably also has had a chilling effect on physician-industry relationships.  Will physician groups that advocate for or against changes in Medicare likewise be challenged to divulge their Medicare income?  Will this be one more reason for some docs to become a "private physician?"  Stay tuned!

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