By Valentine J. Burroughs, MD, MBA, Editor-In-Chief, Medical Practice Issues and Senior Medical Advisor, Health Power
In part of the broad move to make the nation’s health care system more transparent, information about physician payments was released for the first time by the the federal Center for Medicare and Medicaid Services (CMS) on April 9, 2014. Now the public, researchers, policymakers, watchdog agencies and insurance companies will be able to obtain data on services and procedures provided to Medicare patients by physicians and other health care professionals. The new data will allow comparisons by physician, specialty, location, types of medical service and procedures delivered, Medicare payment, and submitted charges.
Making public the amount of Medicare reimbursement for individual physicians is another step in the direction of health care price transparency. Along these lines, in May 2013 CMS published the average charges for over 100 common inpatient services performed at hospitals across the country , and in June 2013, CMS published similar information for over 30 common outpatient procedures including cardiac and pulmonary testing. Last May, hospital charge information was released which allows comparison of what hospitals charge for common inpatient and outpatient services throughout the country.
The intended use of data about physician pay is to create better outcomes and lower costs for patients. In addition to health care price transparency, other benefits of this new policy include allowing providers to collaborate on better care management, giving consumers more reliable measures of quality and performance, and allowing journalists and researchers to identify Medicare waste, fraud and abuse.
The Freedom of Information Act (FOIA), also known as the Sunshine Act, is a portion of the Affordable Care Act which has the stated goal of making health care prices more transparent. Under the FOIA, drug and medical device manufacturers are already required to report any payments made to physicians. Information on how much these companies pay to physicians is available on the CMS Open Payment website and a mobile App operated by CMS.
In response to many concerns about possible uses and misuses of the release of physician payment information to the public, Jonathan Blum CMS Principal Deputy Administrator, said “As CMS makes a determination about how and when to disclose any information on individual physician Medicare payment, we intend to consider the importance of protecting physician’s privacy and ensuring the accuracy of any data released as well as appropriate protections to limit potential misuse or the information.”
Medical Associations are pushing for the option of allowing physicians to review the requests for information about physicians pay before being released by Medicare.
The movement by government agencies toward more transparency and the access to physician data by various categories through the Internet gives a clear signal that physicians will have less privacy from now on. This transparent approach may also have some impact on the public in choosing their physicians, as consumers look at a physician’s profile showing from whom he or she has accepted payments, the amounts and what their Medicare quality performance has been.
Good quality individual physician and group practice performance, well care population health care strategies and careful resource management will be increasingly important going forward. For more information about physician payments, visit CMS.gov.
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