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.
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