CMS Defends Release of Physician Data

CMS is defending its April 9, 2014, release of its Physician and Other Supplier Public Use File (PUF) in an article in the New England Journal of Medicine. The PUF contained data regarding Medicare payments made to physicians and other suppliers in 2012 CMS Administrator Marilyn Tavenner, along with Deputy Administrator for Innovation & Quality and CMS Chief Medical Officer Patrick Conway and Acting Director of the Office of Enterprise Management Niall Brennan, write that the agency released information pertaining to total Medicare payments to individual physicians as part of its commitment to open data. The authors address physicians’ criticism of the move, but note that the release was “part of a broader strategy of data transparency” that will continue to improve the health system.

Background

In the past, a court injunction prevented CMS from publicly disclosing Medicare reimbursement amounts for individual physicians. However, in May 2013, the United States District Court for the Middle District of Florida lifted that injunction. After considering public comments regarding the release of data, CMS released the PUF in April, 2014. It included utilization data for more than 880,000 physicians, amounting to nearly 10 million records that accounted for more than $77 billion in Medicare payments. Since its release, the data have been downloaded or accessed more than 300,000 times.

Response to Criticism

Although CMS contends that reaction to the PUF’s release was generally positive, it addressed criticisms lodged by stakeholders, particularly physicians. In response to arguments that: the data reflect only fee-for-service Medicare claims, rather than their overall practice; patients may not understand that utilization data may not reflect quality of care; and data do not account for differences in severity of illness; CMS suggested a dialogue as to how Medicare Advantage plans, state Medicaid programs, and private health insurers could be encouraged to contribute data for inclusion. The agency also stated its commitment to increasing quality of care data, noting that it has already released a limited set of quality data for physician group practices through its Physician Compare website and plans to release expanded data in the future. Although some critics noted that data set’s size made it inaccessible to all but a small group of users, CMS noted that it has already released an interactive search tool at Data.CMS.gov to assist consumers in navigating the PUF by searching for a physician or supplier name.

Finally, some providers maintain that the information in the PUF is not representative of their practice or that certain information is inaccurate. The agency responds that the data are based on paid claims, which would only fail to reflect certain services coded using the Healthcare Common Procedure Coding System (HCPCS) that have been delivered to fewer than 11 beneficiaries. CMS also indicated that some physicians may not feel that the data is reflective of their practice because they fail to distinguish between fee-for-service Medicare and those in Medicare Advantage. Physicians who truly believe that the data are inaccurate are encouraged to determine whether their National Provider Identifier (NPI) number has been compromised and ensure that they maintain accurate data in the National Plan and Provider Enumeration System database.