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Health Care Reform
June 2014

Widening Gaps in the Wall Obscuring Physician Performance Differences

Author Affiliations
  • 1Stanford's Clinical Excellence Research Center, Stanford University, Stanford, California
  • 2Pacific Business Group on Health, San Francisco, California
  • 3Venrock Partners, Menlo Park, California
JAMA Intern Med. 2014;174(6):839-840. doi:10.1001/jamainternmed.2014.1161

In response to a 2013 judicial decision lifting a 34-year-old injunction, the Centers for Medicare & Medicaid Services (CMS) recently announced that it will release patient-anonymized information about Medicare payments made to individually identified physicians. The only exception will be when the CMS determines that a physician’s right to privacy outweighs the public’s right to scrutinize federal information or the centers’ statutory obligations.

The judicial decision pivoted on enabling the public to assess CMS’s performance in preventing medical fraud. For example, release of information on payments would allow the public to identify physicians whom CMS paid for services rendered on a single day that would require more than 24 hours of a physician's time. However the original injunction had been broadly interpreted by CMS to prohibit release of any payment information pertaining to identifiable physicians. For this reason, the most important consequence of lifting it will be to strengthen the public's ability to assess the performance of individually identified physicians by analyzing Medicare's uniquely large payment database. CMS payment data encompasses demographic information such as patients’ age and sex, as well as diagnoses, testing, and treatment data recorded on bills from all Medicare providers. Such data enable comparisons of physicians’ utilization patterns, frequency of adherence to some clinical guidelines, and treatment consequences.

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