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  • CMS Ready to Release Extensive Payment Data on Individual Providers

    The US Centers for Medicare and Medicaid Services (CMS) is poised to release a publicly available flood of data on individual payments made to over 880,000 providers in the system. The information, which could be posted to the CMS website as early as April 9, would allow anyone to look up an individual provider to track frequency of services, average monthly charges, average monthly payment, and number of beneficiaries treated.

    In an April 2 letter (.pdf) to the American Medical Association (AMA), CMS Principal Deputy Administrator Jonathan Blum wrote that CMS decided to release the data in part to "assist the public's understanding of Medicare fraud, waste, and abuse, as well as shed light on payments to physicians for services furnished." As reported in the Washington Post, The Wall Street Journal, and other news outlets, AMA is opposed to the release of the data due to concerns about physician privacy and worries that the data could be taken out of context.

    Blum wrote that the Freedom of Information Act (FOIA) requests that were the impetus for the change required CMS to "weigh the balance between the privacy interest of individual physicians and the public interest in disclosure." In making the decision in favor of the release, he stated, CMS "did not consider" how someone might use the data because "a requester's personal interest in disclosure is irrelevant to the public interest analysis."

    The data set will be organized by National Provider Identifier Code, Healthcare Common Procedure Coding System code, and place of service (facility or office setting). Each listing will include number of services, average charges and standard deviation, average allowed amount and standard deviation, average Medicare payment and standard deviation, and total beneficiaries treated. CMS will not publish data sets that reflect fewer than 11 beneficiaries and will release no information that would link payments to an identifiable beneficiary.

    CMS also plans on easing the ability of researchers to use these data by, among other actions, lifting the prohibition on redisclosure of physician-identifiable information.

    APTA is engaged in a large-scale initiative to highlight physical therapy's role in eliminating fraud, abuse, and waste in health care. The effort is the subject of a feature article (members-only access) in the February issue of PT in Motion.


    • First they came for the Socialists, and I did not speak out-- Because I was not a Socialist. Then they came for the Trade Unionists, and I did not speak out-- Because I was not a Trade Unionist. Then they came for the Jews, and I did not speak out-- Because I was not a Jew. Then they came for me--and there was no one left to speak for me.

      Posted by Sean on 4/8/2014 2:27 AM

    • How do we go about finding the information? I see the earliest date, but not the location of the information. I for one am excited, as this is a small step towards pay for performance instead of being paid per visit. This information should be made public as soon as possible in order to educate the public regarding practitioner charges.

      Posted by Vince on 4/9/2014 10:24 AM

    • I had the same question as Vince when reading the article - where do we go to find the information. I would like to review my stats in comparison to others. I agree that this information should be made public and will help prospective patient shop for an efficient provider with good outcomes - this is especially important as the Medicare belt continues to get tightened.

      Posted by Dolores on 4/13/2014 6:29 PM

    • This is just another attempt to excite class warfare and justify further cuts. Some of work very long hours six or more days a week. I would be interested in knowing what percentage of those concerned about what other people make are or have ever been in business for themselves.

      Posted by Doug on 4/14/2014 11:21 PM

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