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Kyruus Blog

The Data Puzzle: Industry Comments on Release of CMS Physician Data

Comment Letter Chart Link: KYRUUS COMMENT LETTER CHART

The Data Puzzle: Industry Comments on Release of CMS Physician DataOn May 31, 2013, U.S. District Judge Marcia Morales Howard lifted a 33-year-old injunction that prohibited HHS from disclosing annual reimbursement payments to individual physicians. [1] In her landmark ruling, Judge Morales Howard stated, “[t]he Privacy Act law, upon which the Court’s 1979 FMA Injunction is based, is no longer good law, and thus the permanent injunction rests upon a legal principle that can no longer be sustained.” [2]

In response to the ruling, the Centers for Medicare & Medicaid Services (“CMS”) issued a notice on its website requesting public comments on issues pertaining to the potential release of Medicare Physician Data. The request comes as part of CMS’ demonstrated commitment to promote greater data transparency.

Specifically, CMS asked for comment and input with regard to:

i.) whether physicians have a privacy interest in information concerning payments they receive from Medicare and, if so, how to properly weigh the balance between the privacy interest and the public interest in disclosure of Medicare payment information, including physician-identifiable reimbursement data;

ii.) what specific policies CMS should consider with respect to disclosure of individual physician payment data that will further the goals of improving the quality and value of care, enhancing access and availability of CMS data, increasing transparency in government, and reducing fraud, waste, and abuse within CMS programs; and

iii.) the form in which CMS should release information about individual physician payment, should CMS choose to release it (e.g., line item claim details, aggregated data at the individual physician level).

In total, CMS received over 52 comment letters from market participants that span the entire healthcare ecosystem – from medical societies, physician associations and health systems, to news organizations, non-profit interest groups, public policy think-tanks, researchers and healthcare IT companies.

Kyruus not only submitted comments in response to CMS’ request, but also compiled a comment letter chart (see link above) summarizing each submitter’s key arguments and proposed format for the release of individual physician payment information. Despite commenters approaching the issue from contrasting sides of the aisle, over 85% of commenters (notably physician associations and medical groups) support the release of physician reimbursement data as long as patient privacy is protected, relevant quality information is included and disclosures on the limitation of payment data alone are made.

“Physician interaction is a key component to understanding and coordinating cost-effective, high-quality patient care…it is vital that data on Medicare services provided by individual physicians be made publicly available,” stated Dennis Whalen, President of the Healthcare Association of New York State. [3]

It is clear that we have entered a new era of data transparency, and CMS has already taken necessary steps in recent years to release an unprecedented amount of data in machine-readable format. According to CMS Administrator Marilyn Tavenner, “we’re acutely aware of the huge potential that CMS data holds for creating a more efficient, higher quality health care system.” [4] However, as Jonathan Bush, CEO of Athenahealth, pointed out during his keynote address at this year’s Datapalooza, HHS needs to release even more data in order to empower and enable vendors and data scientists to use data in meaningful ways. [5]

The challenge facing healthcare is not simply finding the data – we have already generated well over 150 Exabytes of data in healthcare and continue to produce new data at a rapid rate – rather, the issue at hand is merging these disparate data sources together in order to drive meaningful insight and actionable intelligence. As argued by 98 medical associations and state medical societies in their comment letter to CMS, “we encourage providing greater access to entities that demonstrate prior experience in handling Medicare data to ensure this information is used in a matter that is safe and protects patient privacy.” [6]

Experienced organizations like Kyruus are well positioned to integrate the massive amounts of information about physicians so health organizations (and their patients) can understand and engage physician expertise across the care continuum.

Delaying the release of Medicare reimbursement data will only hide one more piece of the Big Data puzzle from market participants. We strongly urge CMS to quickly review the comments they have received, and work with stakeholders to develop and adopt data use policies that will make this much-needed data available in a timely manner. Only then can researchers, vendors and healthcare organizations begin to merge the data with other sources to create new applications to help physicians and patients make well-educated care decisions.

 

References:

[1] Fla. Med. Ass’n. v. Dep’t. of Health, Educ., & Welfare, 479 F. Supp. 1291 (M.D. Fla. 1979).
[2] Fla. Med. Ass’n. v. Dep’t. of Health, Educ. & Welfare, 2013 WL 2382270, at 56 (M.D. Fla. May 31, 2013).
[3] Healthcare Association of New York State Comment Letter at 128, Sep. 5, 2013, available at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/PublicComments.pdf
[4] CMS Announces New Data Sharing Tool, Nov. 12, 2013, available at: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-11-12.html
[5] See Jonathan Bush Keynote at Health Datapalooza IV, Jun. 3, 2013, video available at: http://www.healthcareitnews.com/video/jonathan-bush-keynote-health-datapalooza-iv
[6] Joint Comment Letter from 98 medical associations and state medical societies at 36, Sep. 5, 2013, available at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/PublicComments.pdf

Topics: Analytics Provider Networks