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Despite Opposition, CMS Releases Medicare Provider Data

Posted in Hospitals and Institutions, Legislation and Public Policy, Litigation, Medicare and Medicaid, Reimbursement Matters

On April 8, the Centers for Medicare & Medicaid Services (CMS) released data on services and procedures provided to Medicare beneficiaries by over 880,000 healthcare practitioners in 2012. An April 9 email correspondence from the Department of Health and Human Services (HHS) said that the release was “part of the Obama administration’s work to make our health care system more transparent, affordable, and accountable.” HHS also issued a press release with further information.

HHS Secretary Kathleen Sebelius said, “Currently, consumers have limited information about how physicians and other health care professionals practice medicine. This data will help fill that gap by offering insight into the Medicare portion of a physician’s practice. The data released today afford researchers, policymakers and the public a new window into health care spending and physician practice patterns.”

Physician organizations, including the American Medical Association (AMA), have long maintained that releasing such data would violate physicians’ privacy rights. The AMA and the Florida Medical Association were plaintiffs in a lawsuit that concluded in 1979 with a permanent injunction preventing HHS from releasing physician-specific Medicare data, but a new Florida District Court case last May overturned the prohibition. In last year’s decision, the court ruled that physicians’ privacy concerns no longer outweighed the public interest in having access to Medicare data. The availability of the data will allow for greater scrutiny of those physicians who bill Medicare for an unusual number of procedures. However, AMA President Dr. Ardis Dee Hoven expressed concern that “releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences.”

Also last May, CMS released a similar dataset covering hospitals’ charges for many inpatient and outpatient services.

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