CMS Puts Hospitalists in Holding Pattern Regarding Physician Payment Transparency


Hospitalists have little choice but to wait and see when it comes to the release by Medicare of information on how much it pays doctors, according to an SHM committee member.

The decision [PDF] by the Centers for Medicare & Medicaid Service (CMS) to release the data starting in mid-March was long in the making and is aimed at "making Medicare data more transparent and accessible, while maintaining the privacy of beneficiaries," the agency notes on its website.

CMS will respond to individual Freedom of Information Act requests for physician-payment data and generate aggregate data sets regarding Medicare physician services for the public. The agency will make case-by-base decisions on whether to release data and will "weigh the balance between the privacy interest of individual physicians and the public interest in disclosure of such information," according to a notice [PDF] issued last January.

"It all boils down to how the information is released and how the information is going to be interpreted," says SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM. "Generally, most physician groups are supportive of improving access to information…but that's bounded by having context and privacy issues addressed."

In a letter to Congress [PDF], SHM, the American Medical Association, and others have cautioned that the balancing act is a tricky procedure that must take into account the privacy concerns of both patients and physicians. Dr. Lenchus adds that he is skeptical of creating rules to govern the release of information after announcing the intention to release it.

"It tends to make me feel like the horse is already out of the barn, and now we're going to try to corral him back in to some degree," he says. "The case-by-case standard with which they say they are evaluating the [requests] makes sense, but they haven't really defined what their balancing act will be…if there's fraud, waste, and abuse found, it should, of course, be rooted out, but it's tough to root out that abuse just based on the highest-paid cardiologist in your area."

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