Medicare Will Reveal Individual Physician Payments

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The Centers for Medicare and Medicaid Services (CMS) has published rules on how it will comply with requests for the actual dollar amounts it has paid to individual physicians.

For nearly 40 years, this information was held as private by the Department of Health and Human Services (HHS), which oversees CMS, in accordance with a 1979 federal district court decision that found that revealing Medicare payments made to individual physicians violated the physicians’ privacy.

However, last summer, US District Judge Marcia Howard in Jacksonville, Fla., lifted the 1979 injunction against sharing individual Medicare physician payment amounts. The rules CMS published last week in the Federal Register cover how it will respond to Freedom of Information Act (FOIA) requests for information on how much an individual physician made from Medicare now that CMS can no longer automatically hold this information as private. (Click here for the Federal Register publication.)

The new rules call for CMS to make “case-by-case determinations” as to whether the privacy interest of individual physicians or the public interest in disclosure of such information is greater.

The American Medical Association and the Medical Group Management Association were among those who advocated for keeping the information private and urged that, if the information was released, it should be released with appropriate context. For example, payments do not equal income. A salaried physician in a medical group may earn less than what it looks like Medicare paid him or her because the payments are typically redistributed within the medical group to cover practice management costs and the salaries of non-physician staff.

However, media outlets, including Dow Jones, the publisher of the Wall Street Journal, and groups that represent them, like the Society of Professional Journalists, Public Citizen, and the Center for Public Integrity, have urged full disclosure on the basis of a belief that medical practices are no more entitled to privacy than other businesses that receive federal government payments. In addition, those in favor of releasing individual physician payment amounts say making such information public can help fight fraud and abuse in Medicare by bringing to light physicians that make substantially more than the average from Medicare.

The rules will take effect March 18, 2014, when the 30-day comment period on the new rules runs out.

Multiple industry news outlets, including Modern Healthcare and Medscape, predicted the change will further increase the pressure for better price transparency in health care.