Medical Billing Data Made Public to Improve Transparency
New information could be useful for improving care.
- Transparency within the healthcare market may be easier to achieve following the release of the Physician Data File.
The Commonwealth Fund has conducted an analysis of the Obama administration’s data release after the overturning of a court order barring public access to payment information on individual physicians, which dates back to 1979. This analysis details the importance, limitations, and uses of the release of the data.
For providers this new information could be very useful for improving care, such as helping providers choose lower cost but better quality referrals for their patients.
“Greater transparency in the health care sector, achieved by making information on the cost and quality of health services more widely available, ultimately could encourage providers to compete on quality and efficiency and lead to broader improvement in the delivery of care,” the analysis states.
Though there are many benefits, the Centers for Medicare & Medicaid Services (CMS) acknowledges that the data is far from perfect. Limitations* include but are not limited to:
- No information on quality measures for individual providers is included,
- The data is not representative of a provider’s entire practice,
- Facility payments for services provided within the facility are not included, and
- Data is not included for physicians who saw fewer than 11 Medicare patients per year.
*Additional limitations are available on the CMS website.
The decision to release confidential information followed a suit filed by Dow Jones & Co. in 2011, which stated that the 1979 ban “hampered the paper’s reporting since it limited its access to the data and its ability to name physicians and other providers.” The suit’s major goal was stated as being, “essential to rooting out fraud and abuse in the government health-care program.”
Previously, the American Medical Association (AMA) established the 1979 ban by arguing that the Privacy Act of 1974, which prohibited “the disclosure of a record about an individual from a system of records absent the written consent of the individual, unless the disclosure is pursuant to one of twelve statutory exceptions,” also applied to a physician’s right to protect their Medicare claims from the public record.
According to Reuters, Florida judge Marcia Morales Howard chose to overturn this AMA’s original argument because the Privacy Act has since been amended and no longer covers the interpretation the AMA had expressed.
According to the Commonwealth Fund, one suggestion for improving the release of this type of data for the public to use is that “clearer distinctions are needed between provider types” because sometimes specialty categories are ambiguous.”
Additionally, the analysis claims that improving data releases with standardizing cost data could “promote ease of use for everyone” as well as allow data to “be paired with other datasets to create a more comprehensive look at health care system spending, prices, utilization, and clinical practices.”
