The Medicare Physician-Data Release — Context and Rationale (New Eng Jour Med)

[pinto]

The Medicare Physician-Data Release — Context and Rationale

Niall Brennan, M.P.P., Patrick H. Conway, M.D., and Marilyn Tavenner, R.N., M.H.A.
May 28, 2014

On April 9, the Centers for Medicare and Medicaid Services (CMS) released detailed information on utilization by more than 880,000 physicians and other health care providers who care for Medicare beneficiaries. This data release was unprecedented in its size and scope: it included nearly 10 million records accounting for more than $77 billion in Medicare payments. The data have been downloaded or accessed more than 300,000 times from the CMS website since their release. But because the release has also come in for some criticism, it may be helpful to clarify its context and rationale.

In one of his first acts in office, President Barack Obama issued a memorandum calling for more open, participatory, and collaborative government, and in May 2013, he issued an executive order mandating implementation of an open-data policy in all federal departments. We at CMS have embraced this directive and worked to identify information and data that could be made publicly available even as we maintain safeguards to protect the privacy of our beneficiaries. We believe that greater transparency in the health care system can drive improvement in health and contribute to the delivery of higher-quality care at lower cost and that CMS can play an important role in stimulating a vibrant health-data ecosystem. By making data files available as “raw material,” we aim to enable innovators and entrepreneurs to maximize the data's value for a wide array of users.

Examples of this commitment to open data include the Medicare Geographic Variation Public Use File and the Medicare Provider Utilization and Payment Data inpatient database — the former includes information on fee-for-service Medicare spending, utilization, and quality at the state, hospital referral region, and county levels, and the latter contains information on individual hospital utilization, submitted charges, and payments for the 100 most frequently occurring diagnosis-related groups in the Medicare program. The release of these data in 2013 sparked a national conversation about the appropriateness of hospital charges and about the large variation in charges for the same service, often in the same geographic area. These data sets are just two of the many that CMS and the Department of Health and Human Services have released over the past several years. Users can find these publicly available data sets and others by visiting the CMS Data Navigator (http://dnav.cms.gov/), Data.CMS.Gov (https://data.cms.gov/), and HealthData.gov (http://healthdata.gov/).

Until May 2013, however, CMS was prohibited from disclosing information on total Medicare payments to individual physicians, owing to a 1979 court injunction declaring that such disclosures would constitute unwarranted invasions of physicians' personal privacy. On May 31, 2013, a Florida federal district court issued an order vacating the 1979 injunction. In its decision, the district court did not address whether physicians' privacy interests in their payment information had diminished since 1979; instead, the court concluded that the injunction lacked a legal basis for continued enforcement. CMS then proceeded in a deliberative and open fashion to determine the most appropriate policies with respect to disclosure of individual physicians' payment data. In August 2013, we issued a request for information seeking public comment on the matter; in response, more than 130 comments were submitted identifying potential benefits and concerns.1 Ultimately, we concluded that these data were essential for shedding light on health care spending and physicians' practice patterns in Medicare.

http://www.nejm.org/doi/full/10.1056/NEJMp1405026?query=TOC