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CMS makes physician payments data accessible, causing open-data squabble

Physicians' Medicare payment data, once completely private, can now be accessed by way of a formal request to CMS.

In a change that was more than 30 years in the making, disclosure of Medicare-related physician payments is now permitted under the Freedom of Information Act. This ruling was made by CMS to further the effort of more accessibility and transparency of data in order to help improve quality and care while ultimately giving patients the chance to understand where they can get less-expensive care.

This move is a significant change to the former policy, which kept the financial information associated with physicians who provide care to Medicare and Medicaid beneficiaries private. The previous stance of CMS on the physician payments issue was officially established in 1980 and received criticism because it stood in the way of sharing information that is in the public's interest.

Organizations looking to gain access to physician payment information will still be required to submit their request to CMS, which in turn will evaluate and make a determination whether Exemption 6 of the Freedom of Information Act -- which protects personal privacy interests -- applies.

Once the payment data is released, the recipient will have the ability to apply analytics and mine it for insights. Some of the areas under close examination may include:

  • Analysis on physicians' payments for procedures by region, state, city and county.
  • Comparative analysis of federal reimbursement payments amongst providers.
  • Measure the performance of and create quality benchmarks for individual physicians.
  • Financial incentives available to physicians participating in accountable care organizations and other shared savings programs.
  • Fraud detection and evaluation of physician's reimbursements.

As technology developers and data scientists mine the information that will be made accessible to them, the true value and potential of all this data can be realized. The release of physician payment information by CMS will be a win-win for everyone if it motivates providers to innovate and creates ways to improve care and reduce costs. Despite the advantages that could be gained from the release of such information, there are several groups voicing privacy concerns on the behalf of physicians.

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 healthcare industry. Let us know what you think about the story; email or contact @SearchHealthIT on Twitter.

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