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Bryan Spivak new HHS

CMS seeks comment on how to release doc pay data without compromising privacy

By Andis Robeznieks
Posted: August 9, 2013 - 1:45 pm ET

The CMS is seeking public comment on how best to make physician-specific Medicare payment data publicly available while also protecting the privacy of patients. Physician organizations have vigorously opposed the release of physician-specific data but the dike appears to be crumbling.

Since 1979, public release of payment information had been prohibited by a court injunction resulting from a Florida Medical Association lawsuit. But, on March 31, the injunction was vacated by U.S. District Judge Marcia Morales Howard in Jacksonville, Fla.

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“The question before the Court at this stage of the proceedings is not whether the information protected from disclosure by the 1979 FMA Injunction should be disclosed now or ever,” Howard wrote in her decision. “It is not whether the injunction was wrongly or rightly entered in 1979. The narrow question before this Court is whether 'a significant change in either factual conditions or in law' renders continued enforcement (of the 1979 FMA Injunction) 'detrimental to the public interest.'”

She ruled that continued enforcement is detrimental. Now it's up to the CMS to figure out how to release the data.

At issue, according to the CMS request for comment, are the privacy rights of physicians regarding payments they receive; what CMS policies should considered so that the release of the data will further the CMS goals of increasing quality, transparency and value; and in what form the data should be released. For example, should it be in the form of line-item claim details or aggregated data for individual doctors?

In a blog on, HHS Chief Technology Officer Bryan Sivak described the upcoming data release as an opportunity for analysis, research and program improvement.

“We know from recent experiences with the release of hospital charge data on the top 20 diagnostic codes that there are many users with ideas to apply these data to create new tools, and services to improve performance,” Sivak wrote. “Provider-level cost data will unleash another round of innovation.”

Comments must be delivered to the CMS or submitted to before Sept. 5.

Meanwhile, a bipartisan bill has been introduced in the U.S. House of Representatives that would require disclosure of Medicare payment information on individual physicians and other healthcare providers and suppliers, to enable the public to compare providers of services.

The Medicare DATA Act would amend federal public-information laws to remove a privacy loophole that has prevented the release of physician-specific Medicare payment data for decades. Proponents say such transparency could lead to closer scrutiny of high-cost doctors and could provide insights on which Medicare doctors have the best clinical track records. The AMA and the federal government have long opposed such disclosure, saying such data can be misleading and that this would violate physicians' privacy.

At issue is the Medicare claims database, which includes information on which doctors and other providers and suppliers bill Medicare, for how much and for what services.

There is growing pressure for healthcare providers to disclose prices, as part of a move to a more consumer-directed healthcare system.

Follow Andis Robeznieks on Twitter: @MHARobeznieks

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