Individual Doc Medicare Payments Go Public

The Centers for Medicare and Medicaid Services (CMS) announced on January 14, 2014, that the agency is going to start disclosing by March 17, 2014 how much money individual physicians earn treating Medicare patients.

The information is not going to be disclosed in a massive report, but will be released in response to Freedom of Information Act (FOIA) requests. The agency will evaluate requests for such information on a case-by-case basis, and will use a balancing test to determine what information should be released.

Our friends at Policy and Medicine (PM) noted that Exemption 6 of the FOIA permits the government to withhold all information about individuals in “personnel and medical files and similar files” when the disclosure of such information “would constitute a clearly unwarranted invasion of personal privacy.” This exemption may still shield some information from public view if the damage to physician privacy is judged greater than the public interest in the information. Furthermore, CMS states that in no case would such disclosures reveal the identities of individual patients.

Until this new policy was put in place, the agency had always said that public interest in disclosure of the amounts paid to individual physicians under Medicare was never sufficient to outweigh doctor privacy, and FOIAs would not compel disclosure of Medicare payments. But a recent federal court decision said such a broad injunction was not authorized under the Privacy Act. The public interest in detecting trends in healthcare utilization and fraud now trumps physician privacy when taking public funds.

As we reported in August, the agency was taking public comments about releasing such information. According to PM, the agency reviewed more than 130 comments from 300 organizations before announcing the final rule. Family Practice News reports that physician groups, including the American Medical Association (AMA), urged CMS to use caution in releasing physician data. “Medicare data is highly susceptible to misleading conclusions, ” the letter signed by AMA stated. “CMS should undertake a detailed educational program to explain any Medicare data release program and openly address its limitations, including that the data may take into account only a small fraction of a physician’s patient population or may be outdated.”

Thomas Sullivan of PM said it will be interesting to see how much of this information is used by the legal community in malpractice and class action lawsuits. He added that the FOIA responses could potentially be a huge addition to the big data movement, considering the immense size of the CMS database.