US will disclose Medicare’s payments to doctors

BMJ 2014; 348 doi: (Published 07 April 2014) Cite this as: BMJ 2014;348:g2610
  1. Michael McCarthy
  1. 1Seattle

The US government announced on Wednesday 2 April that it will publicize the payments that Medicare makes to individual doctors.

The data will contain detailed payment information on 880 000 healthcare professionals for services that they have provided to Medicare beneficiaries under the program’s Part B “fee for service” program, which covers outpatient care.

The data, which may be released as early as next week, will cover payments for $77bn (£46.4bn; €56.2bn) paid out by Medicare to healthcare providers in 2012.

In a blog post on 2 April Jonathan Blum, principal deputy administrator of the Centers for Medicare and Medicaid Services (CMS), said that the goal of the release was to make the US healthcare system more transparent and accountable.1

“Data like these can shine a light on how care is delivered in the Medicare program. They can help consumers compare the services provided and payments received by individual health care providers. Businesses and consumers alike can use these data to drive decision-making and reward quality, cost-effective care,” Blum wrote.

The data will include information about the medical services and procedures provided by doctors and other healthcare professionals, as well as data on the payments and charges related to those services.

To protect patients’ privacy, patient information will be de-identified and information will be withheld for providers who have billed for fewer than 11 beneficiaries.

The government had been prohibited from releasing payment information about individual doctors for more than three decades after a 1979 court ruling found that doing so would violate the physicians’ right to privacy. That decision, however, was overturned last year, prompting Medicare to review its policy.

In a letter to the American Medical Association—which, citing privacy concerns, has long opposed the release of such information—Blum said his agency had concluded that the release was required under the Freedom of Information Act, the 1966 law that gave people the right to obtain access to federal agency records.2

“[T]he Department [of Health and Human Services] weighed the privacy interests of physicians and the public’s interest in shedding light on government activities and operations and has determined that the public’s interest outweighs the privacy interests,” Blum wrote in the letter, which the CMS released on Wednesday.

The release of the information would help to uncover instances of waste, fraud, and abuse, Blum wrote, and “will also allow a more informed debate about the appropriate Medicare payment for particular services.”

In a statement published in response to the announcement Ardis Dee Hoven, the American Medical Association president, called on the CMS to allow doctors to review and correct their information before their data were released.

“The AMA is concerned that CMS’ broad approach to releasing physician payment data will mislead the public into making inappropriate and potentially harmful treatment decisions and will result in unwarranted bias against physicians that can destroy careers. We have witnessed these inaccuracies in the past,” Hoven said.

She also said that any analysis of data should make clear the methodologies used so that users could understand the limitations. “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.


Cite this as: BMJ 2014;348:g2610