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Medicare data release

from AAGP

On April 8, the Centers for Medicare and Medicaid Services posted searchable, physician-specific Medicare claims data on its website. The spreadsheet files show for each physician their NPI, name and address, average charge and Medicare payment amounts, unique beneficiary counts, and other information for the various Medicare services they provide.

It is the understanding of the American Medical Association, AAGP, and other physician organizations that CMS has received a very large volume of Freedom of Information Act requests for the data that the agency did not feel could be handled on a case-by-case basis. These FOIA requests were the result of a recent court decision that reversed an injunction that previously prevented CMS from making the data available to the public. Given the broad interest in viewing the data, CMS determined that it should be made public and accessible to all. Similar information has been available for several years on Medicare hospital payments.

While AAGP understands and appreciates the growing interest in price transparency and believes that cost and quality data can be used appropriately to help improve care, there should be safeguards to protect physicians and patients from misuse of inaccurate or misleading data. Many of these safeguards were included in data release provisions of the bicameral, bipartisan strategic growth rate repeal legislation (H.R. 4015/S.2000) that was introduced in the House of Representatives and Senate earlier this year. Unfortunately, the data posted by CMS are not subject to these safeguards. Physicians were not given the opportunity to review their data for accuracy prior to their publication and users of the data are not required to disclose the methodology they use in manipulating it. There needs to be responsible use of the data. For example, more than one provider may submit bills under a physician’s NPI so that conclusions that one physician is responsible for an extraordinarily high service volume may not be accurate.

AMA has advised AAGP that it is examining the data and is also exploring opportunities to help physicians respond as individuals to inquiries they may receive about their personal data. Information about the analyses will be provided when it is available. more

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