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Medicare to release billing data for 880K doctors
Thursday - 4/3/2014, 10:20am EDT
WASHINGTON (AP) -- Patients may soon get an unprecedented look at how their doctor compares to other physicians, after Medicare announced Wednesday it plans to publicly post billing data for more than 880,000 practitioners.
Considered the mother lode of information on doctors, the Medicare claims database has been off-limits to the public for decades, blocked in the courts by physician groups. The American Medical Association has argued that its release would amount to an invasion of doctors' privacy. Consumer groups, insurers, employers and the news media have sought the information to help them evaluate clinicians.
Wednesday, the Obama administration came down on the side of disclosure.
Medicare Deputy Administrator Jonathan Blum said in a letter to the American Medical Association that the agency intends to post the data publicly as early as next week, April 9.
"Over the past 30 years, the landscape has changed with respect to physician information that is available to the public," wrote Blum. "As a result, the health care system is changing from a system dominated by dearth of usable, actionable information to one where care coordination and dramatically enhanced data availability ... will power greater innovation, higher quality, increased productivity and lower costs."
The AMA is concerned that the release of information planned by Medicare will mislead people into making "inappropriate and potentially harmful treatment decisions and will result in unwarranted bias against physicians that can destroy careers," the association's president, Dr. Ardis Dee Hoven, said in a statement.
The AMA recommends that physicians be allowed to review and correct their information before Medicare releases it, Hoven said. "Taking an approach that provides no assurances of accuracy of the data or explanations of its limitations will not allow patients to draw meaningful conclusions about the quality of care," she said.
Doctor ratings have often been based on the opinions of other doctors. The Medicare billing files would usher in a new era of hard data. Doctors could be tracked and evaluated the same way that baseball players are -- using statistics.
Supporters of disclosure say the information will help lead consumers to doctors who have the greatest expertise and who get the best results. For example, if you're about to undergo heart bypass, you could find out how many operations your surgeon did last year. Research shows that for many procedures, patients are better off going to a surgeon who performs them frequently.
The data could also be used to spot fraud, such as doctors billing for seeing more patients in a day than they would reasonably be expected to care for.
But doctors worry that some physicians could be unfairly singled out. They point to the example of clinicians practicing in economically depressed areas, seeing patients who can't afford medication copays or who don't follow through with basic self-care. The numbers may not look so good for those doctors, but it may not be because of anything they did wrong.
Officials say the files contain data on every test and procedure billed for in 2012 by individual doctors in all 50 states, who together received $77 billion that year through Medicare's Part B coverage for outpatient services. It will amount to close to 10 million lines of data. Doctors who saw fewer than 11 Medicare beneficiaries will be excluded.
Although individual patient information will remain off-limits, the files will identify physicians by name.
The Obama administration has been inching toward fuller disclosure for months, driven in part by provisions of the new health care law, but also by legal pressure from The Wall Street Journal and other media organizations.
"Release of physician-identifiable payment information will serve as significant public interest by increasing transparency of Medicare payments to physicians ... and shed light on Medicare fraud, waste and abuse," wrote Blum.
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