Will Medicare Publish Information on Payments to Anesthesiologists and Other Physicians?

In May of this year, CMS released information on the average charges for the one hundred most common inpatient services at more than 3,000 hospitals nationwide.  The following month, the Agency published average charges for 30 outpatient procedures.  Are average charges—or payments—for physicians’ professional services next?

CMS would like to make physician payment data available, being strongly committed to greater data transparency in general.  Accordingly, it has published a request for public comments, in which it noted that “Since 2010, CMS has released an unprecedented amount of aggregated data in machine-readable form. These data range from previously unpublished statistics on Medicare spending, utilization, and quality at the state, hospital referral region, and county level, to detailed information on the quality performance of hospitals, nursing homes, and other providers.”  The questions on which CMS seeks comments are the following:

(1) whether physicians have a privacy interest in information concerning payments they receive from Medicare and, if so, how to properly weigh the balance between that privacy interest and the public interest in disclosure of Medicare payment information, including physician-identifiable reimbursement data;
(2) what specific policies CMS should consider with respect to disclosure of individual physician payment data that will further the goals of improving the quality and value of care, enhancing access and availability of CMS data, increasing transparency in government, and reducing fraud, waste, and abuse within CMS programs; and
(3) the form in which CMS should release information about individual physician payment, should CMS choose to release it (e.g., line item claim details, aggregated data at the individual physician level).

Until recently, an injunction issued by a Florida federal district court in 1979 had prevented the government from disclosing Medicare payments to individual physicians, except in connection with a valid Freedom of Information Act request.  The Department of Health and Human Services joined Dow Jones & Company and Real Time Medical Data in petitioning the court to lift the injunction, which it did on May 31st.  The time to appeal ran out on July 30th and the decision vacating the injunction now stands.  CMS is therefore considering lifting its policy, adopted in 1980, stating that “the public interest in the individually identified payment amounts is not sufficient to compel disclosure in view of the privacy interests of physicians.”

The AMA and other medical societies have long opposed the publication of data on individual physicians’ earnings.  They contend that such data would violate physicians’ privacy, which may well be true, and that they would be misleading, which is very likely the case.  How well does the public understand the difference between charges or claims submitted, on the one hand, and payments actually made, on the other, or the variable relationship between bills and allowable amounts?  

Consider the hospital chargemaster data that CMS released in May.  There are enormous variations in the charges for the same procedure (by DRG) from one hospital to another, even within the same metropolitan region, as in the case of Denver, CO, where hospital charges for treating heart failure range from $21,000 to $46,000.  The differences between high-cost and low-cost areas are sometimes staggering; the charge for a joint replacement ranges from $5,300 at a hospital in Ada, OK to $223,000 at a Monterey Park, CA facility. 

These figures are irrelevant to the vast majority of patients, though, since these patients have insurance, whether private or Medicare, which pays much lower amounts that may have nothing at all to do with the charges.   The data release thus confirms what many people already know, that there is no relationship between costs and charges when it comes to hospital prices.  We are still a very long way from having any database that permits comparison shopping.  Nevertheless, CMS plans to fund the creation of “health care pricing data centers” to increase public awareness of the hospital charge information in the hope “that consumers, businesses, and insurers will shop for better deals based on the data, and that hospitals will be embarrassed into charging uninsured Americans prices for health care that are more in line with what Medicare or other insurers pay.” (Reichard J. Washington Health Policy Week in Review: CMS Posts Data Showing Big Hospital Price Swings.  The Commonwealth Fund, May 8, 2013).

Publication of Medicare payments to physicians would create less furor because charges play even less of a role in determining the allowable amounts.  As the CMS request for public comments notes, “Changes in the Medicare reimbursement system … have resulted in greater standardization of payment amounts for physician services.”  Indeed, anyone who knows the CPT™ code on which a medical claim is based and the physician’s geographic area can look up the payment amount through the CMS Physician Fee Schedule look-up tool.  Data on the frequency with which an individual physician bills a particular service, however, or total payments for that service, could raise questions of fraud, waste and abuse.

Whatever the validity or utility of the data, governmental interest in its publication is growing.  In June, Sen. Charles Grassley (R-IA) and Sen. Ron Wyden (D-OR) reintroduced the Medicare Data Access for Transparency and Accountability Act which would require “the Secretary of Health and Human Services to make available a searchable Medicare payment database that the public can access at no cost.”

Readers who would like to comment on CMS’ questions about releasing physician payment data may submit letter to Physician Data Comments@cms.hhs.gov up to 5:00 pm on September 5, 2013.

Another area in which CMS is seeking input from the public concerns future quality measures for public reporting and the Physician Compare website.   Here the Agency is seeking nominations for individuals to serve on a “technical expert panel” that will provide ongoing advice.  Below is the CMS announcement:

Seeking Nominations for Physician Compare Quality Measurement Technical Expert Panel — August 22 Deadline

CMS is seeking nominations for the Physician Compare Quality Measurement Technical Expert Panel (TEP). The TEP will provide expert feedback on physician quality measures that have been proposed for public reporting and make recommendations regarding future quality measures for public reporting on the Physician Compare website. CMS is seeking nominations from individuals with the following areas of expertise and perspectives:

• Public reporting of health care performance data/CMS Compare sites
• Reliability and validity testing
• Risk models and risk adjustment
• Performance measurement
• Quality improvement
• Consumer perspective
• Health care disparities

CMS is also looking for patients or their caregivers to join the TEP to provide feedback on the Physician Compare website. To nominate an individual for the TEP, please submit the following set of materials:

• A completed and signed TEP Nomination/Disclosure/Agreement form
• A letter of interest (not to exceed two pages), highlighting experience/knowledge relevant to the expertise described above and involvement in measure development
• Curriculum vitae and/or list of relevant experience (e.g., publications), a maximum of 10 pages total

More information, including the TEP Nomination/Disclosure/Agreement form, will be available on the TEP web page soon. If you wish to nominate yourself or other individuals for consideration, please complete the form and email it to PhysicianCompare@Westat.com. Nominations are due by close of business August 22, 2013 ET.

ABC encourages our readers to consider these two opportunities to make anesthesiology’s voice heard in the development of CMS policy.