Should the Public Have Access to Doctors’ Claims Data?

Recently, a federal court in Florida vacated a 33-year-old injunction that had prevented HHS from releasing lists of physicians who had received Medicare payments and the amounts that Medicare paid  them. There will be no massive, immediate disclosures; anyone wanting the information will have to make a request under the Freedom of Information Act (FOIA), 5 USC sec. 552. However there has been some grumbling and speculation that disclosures could be the last straw that prompts physicians to stop accepting Medicare payments.

There were two parties that moved to set aside the injunction: Dow Jones, owner of the Wall Street Journal, and Real Time Medical Data, LLC (RTMD). The Wall Street Journal used a subset of the data to report on Medicare fraud and abuse, though CMS barred the publication of any physicians’ names. RTMD uses the data as a consultant to hospitals and practitioners on marketing and strategic planning.

Although the American Medical Association is considering an appeal, the trend in Medicare is toward transparency in general and quality reporting in particular. These concerns are likely to trump physicians’ interest in privacy. On June 18, 2013, Senators Charles Grassley (R.-Iowa) and Ron Wyden (D. Ore.) reintroduced the Medicare Data Access for Transparency and Accountability (DATA) Act, which would require disclosure of payments to Medicare providers similar to the disclosure of federal payments to other contractors and grantees at http://www.usaspending.gov/.

The Open Payments Law

Congress and CMS already have determined that the public interest outweighs the interests of physicians and providers in financial privacy by enacting section 6002 of the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148), which established the National Physician Payment Transparency Program (OPEN PAYMENTS). This initiative requires group  purchasing organizations (GPOs) and manufacturers of drugs, biologicals, supplies, and medical devices to report to CMS  the payments and transfers of anything of value they make to physicians or teaching hospitals. They also must report ownership or investment interests held by physicians and their immediate family members during any part of a year. CMS will aggregate the information and post it on a web site. The Final rule, which became effective April 9, 2013, establishes August 1, 2013 through December 31, 2013 as the first reporting period.  Manufacturers and GPOs must report the data for this period by March 31, 2014. CMS will post it by September 30, 2014. Physicians and teaching hospitals will register in 2014 so that they can access the information reported about them and request corrections. Although physicians are not required to register, they must do so in order to request dispute the reported information or request corrections. The OPEN PAYMENTS program is designed to shed light on financial relationships to inform consumers, prevent conflicts of interest, and reduce the risk of unnecessary health care spending.