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Court rules in favor of healthcare cost transparency; will CMS follow?

CMS is seeking public feedback on whether to release individual physician's Medicare reimbursement data.

CMS has been more transparent under the current administration, offering some insight into its reimbursement methods. Many parties within U.S. healthcare are leveraging data made available through CMS' disclosure.

In many cases, this information is being utilized for performance reports, procedures and other health-related analysis. But CMS continues to push for further data to be made available. Its latest cost transparency effort means that in the future we could see exact physician reimbursement details.

The new initiative is not fully implemented yet, as CMS has to overcome the spirit of a 1979 Florida injunction that placed this information as private, covered by the Privacy Act. While the injunction was lifted earlier this year, CMS indicated it's reticent to release such data unless it receives enough support from the public. To take the pulse of public sentiment, the agency released a request for public comment on the issue.

CMS wants to confirm that the release of this information would serve a greater good to the public; if the public comments don't support this idea, then it might never be able to justify making the data sets downloadable.

The data in question through this proposed initiative would have significant value for many, as it would provide specific details around Medicare payments made to physicians. CMS stated within its request for public comment document that the following items need to be addressed as part of its request for public feedback:

  • How to properly weigh the balance between any potential privacy interest a provider has and the public interest in disclosure of Medicare payment information.
  • What specific policies CMS should consider with respect to disclosure of individual physician payment data, especially in order to prevent the release of any health information on any Medicare beneficiary.
  • What form any potential data release might take (e.g., line item claim details, aggregated data at the individual physician level).

It's important to recognize that this information once made available and similar to previous information will likely raise some concerns from physicians. The data to be released would make it possible for anyone to expose some information around procedures performance for specific patient cases, which in turn could be used as a means to identify if some physicians are performing the appropriate procedures.

Also, if line items are also disclosed, the data could be used to identify physicians with the highest number of procedures performed during a given period of time. That could be used to gauge a physician's patient volume or experience per period compared to competitors.

There are many potential use cases for this reimbursement data. While there are still some legal issues that CMS needs to address, making this data public should still be seen as a step toward more healthcare cost transparency, and therefore a value-add to the public's interest. This further confirms that an increasing amount of data is becoming widely available, and continues to push more hospital IT executives and others to implement and support big data and other business intelligence initiatives.

About the author:
Reda Chouffani is vice president of development with Biz Technology Solutions Inc., which provides software design, development and deployment services for the health care industry. Let us know what you think about the story; email or contact @SearchHealthIT on Twitter.

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