Helping patients learn more about their health and their choices may keep them out of the office, but will helping them learn about how much their physicians receive from Medicare do the same? A survey by the American College of Physician Executives (ACPE) found that physicians are leery of the thought of their Medicare payments being made public after a judge lifted a 1979 injunction that kept the data private.
At the beginning of August, CMS released a public request for information seeking comment on how physicians would feel if their payment data was exposed for all to see. While this information was nearly always available under the Freedom of Information Act when a request was specifically made, a 1979 court ruling stated that physician privacy trumped the right of the public to know what their doctors were billing for and how much tax money they received from Medicare for their services. HHS wrote in 1980 that “the public interest in the individually identified payment amounts is not sufficient to compel disclosure in view of the privacy interests of the physicians,” but a recent court case overturned that view.
As healthcare costs spiral out of control and organizations from every segment of the industry seek ways to keep a lid on expensive treatments, unnecessary hospital admissions, and costly chronic diseases, that information has become increasingly relevant to patients and payers alike. Physicians, however, are divided on whether or not CMS should make the information public and whether or not it will actually help patients make better healthcare decisions if they do so.
The ACPE survey found that opinions were fairly evenly split: 46% of the nearly 600 respondents believed the information should stay locked up, while 42% were in favor of releasing the data. The remaining 12% were unsure.
“The lay public is not equipped to handle this type of information,” wrote one respondent. “They do not understand the concept of overhead. They do not know that as an ER doc I collect 30% of what I bill. Imagine the frenzy when the media sums up the payments and reports Dr. X’s income from Medicare. The reporting of this info will only lead to more doctor-bashing at a time when smart young people are avoiding entry into medical school like the plague.”
“This information would be useful in facilitating public understanding that it is not ‘greedy doctors’ that have made healthcare so expensive, but rather, increasing healthcare system overhead, drug and device costs, hospital charges, facility fees, and malpractice fees,” argued another. “Doctor professional-visit fees from Medicare are a very small part of the overall Medicare payment distribution and the public should have that information.”
Others said that as a publically-funded program, patients have a right to know where their tax dollars are going. Another pointed out that if CMS made physician payments public, it would only be fair to release how much Medicare money was spent on individual patients, too.
Physicians are generally wary of being ranked and rated by the public, another ACPE survey found last year, with 26% of members saying online consumer rankings were a straight-up “nuisance” to them. But with the growing emphasis on patients as partners and valued consumers with more choices about their care instead of a necessary evil, CMS and others are lavishing much more attention to quality and value rather than paying in bulk for quantity.
“Any type of measurement in public reporting is ultimately trying to improve the system,” ACPE CEO Dr. Peter Angood told PhysBizTech. “Just going to your doctor and having a feel-good experience doesn’t necessarily mean you got really good healthcare. We have to continue improving the quality of measurement and reporting so that the patients are able to understand when we have these ratings systems out there, what’s really accurate.”
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