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Medicare Blog | Medicare News | Medicare Information

Plans to disclose physician reimbursement fee may be underway

Posted by Guadalupe Cantu on Fri, Jan 17, 2014 @ 10:50 AM

Medicare Supplements A new policy that informs the public how much money Medicare pays individual doctors may be underway and could violate physicians' privacy rights if poorly handled, warns the American Medical Association.

The Department of Health and Human Services (HHS) has announced that it will start responding to Freedom of Information Act requests for physician-payment data. Government officials will be using a ‘balancing test’ to determine who gets access to the information, and not guaranteeing the data to all filed request. This has prompted groups to say the administration needs to do much more in making payment data broadly accessible and transparent.

Under the FOIA's privacy exemption, some of the doctor’s information may be kept from public view if the damage to physician privacy is deemed greater than the public interest. Disclosure of the doctor’s data will exclude patients information; however, the information released will depend on the outcome of the “balancing test”, which varies by circumstance, analysis, facts, and per case. In all cases, the HHS says they “are committed to protecting the privacy of Medicare beneficiaries.”

In addition, the Center for Medicare & Medicaid will begin “aggregating” data sets about Medicare physician services, 60 days after the new policy appears in the Federal Register.

Disclosure of doctor payment data “from government healthcare programs must be balanced against the confidentiality and personal privacy interests of physicians and patients who may be unfairly impacted by disclosures” says Dr. Ardis Dee Hoven, president of the AMA, who has long opposed the release of data.

Over the past 3 decades, Medicare physician-payment data has been highly sought by media groups, government watchdogs and private organizations. They argue that the disclosure of information informs consumers of a doctor’s competence, performance, and highlights any possible abuse or fraud. The release of information should only be done in the efforts of “improving the quality of healthcare services and with appropriate safeguards,” Hoven said.

Critics against disclosure argue that the release of information would reveal proprietary details the general public does not need to know, and that inaccurate data presentation would damage a doctor’s reputation.

In spite of responding to Freedom of Information Act requests for physician-payment data, the government is not planning to put the entire Medicare physician-payment data online in a searchable format. It will require individuals seeking data to submit specific request under the FOIA’s. Any information that gets released will be filtered and judged by its worthiness, and will take physicians privacy concerns into consideration.

On May 2013 a 1979 federal injunction ruling, that barred the release of Medicare payment data and identified doctor’s specifics, was dissolved by U.S. District Judge Marcia Morales Howard in Jacksonville, Fla., ruling on the grounds that physicians' privacy concerns no longer outweighed the public interest.

Following the ruling, CMS followed suit to and decided to release physician-payment data, citing disclosure under the Freedom of Information Act. Disclosure of the data will be determined on the outcome of the “balancing test,” as a result every case will be treated as an individual basis (FR Doc. 2014-00808).




Please give us your feedback!
Question: Will disclosing physician fees help stop Medicare fraud and save money in the long run or will it have an adverse effect and persuade more physicians to stop accepting new Medicare patients?

Source: ModernHealthCare
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Tags: Centers for Medicare & Medicaid Services, Department of Health and Human Services, HHS, physician reimbursement fee, privacy rights, Medicare, Medicaid, CMS

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