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Medicare may divulge what it pays physicians

In a reversal of 30 years' past practice, Medicare may start to disclose what it pays individual physicians for its services to seniors.

The Health and Human Services Department released a notice Tuesday that it was modifying its policy regarding requests made under the Freedom of Information Act about the amounts paid to individual physicians under Medicare.

The Centers for Medicare & Medicaid Services will make case-by-case determinations as to whether a specific exemption applies to a request for the payment information under the Freedom of Information Act. That exclusion, referred to as Exemption 6, requires CMS to weigh the balance between the privacy interest of individual physicians and the public interest in disclosure of such information.

"As the outcome of the balancing test will depend on the circumstances, the outcomes of these analyses may vary depending on the facts of each case," the notice said.

In a blog post, Jonathan Blum, CMS principal deputy administrator, explained that the change was a step forward "in making Medicare data more transparent and accessible, while maintaining the privacy of Medicare beneficiaries." 

Under the change in policy, which is set to take effect in March, CMS will also generate and make available aggregate data sets regarding Medicare physician services. This, Blum noted, may help enable providers to collaborate on improved care management and healthcare delivery at lower costs and offer consumers broader, more reliable measures of provider quality and performance.

In 1980, physicians' privacy outweighed public transparency based on the outcome of a Florida Medical Association lawsuit in which the district court permanently barred disclosure of identifiable annual Medicare reimbursement payments of individual physicians or disclosure of payments in a manner that could identify individual physicians.

However, the district court vacated its permanent injunction in May 2013, after further case law by the U.S. Court of Appeals decided in Edison v. Department of the Army that the injunction was no longer authorized under the Privacy Act. CMS then sought public comment in August 2013 on proposed policies under which to divulge individual physicians' payment information, receiving 130 comments from 300 organizations.

The notice of the policy change will be officially published in the Federal Register on Jan. 17 and take effect 60 days after that.

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