Medicare Spending Data May Be Publicly Available Under New Policy
by Gavin Baker, 1/17/2014
On Jan. 14, the Centers for Medicare & Medicaid Services (CMS) announced a new policy that could bring greater transparency to Medicare, one of the largest programs in the federal government. CMS revoked its long-standing policy not to release publicly any information about Medicare’s payments to doctors. Under the new policy, the agency will evaluate requests for such information on a case-by-case basis. Although the impact of the change is not yet clear, it creates an opportunity for a welcome step forward for data transparency and open government.
Medicare’s tremendous size and impact – expending an estimated $551 billion and covering roughly 50 million beneficiaries in 2012 – mean that increased transparency in the program could have big effects. Better access to Medicare spending data could permit consumers to evaluate doctor quality, allow journalists to identify waste or fraud, and encourage providers to improve health care delivery.
Until now, the public hasn’t been able to learn how much Medicare pays to particular medical businesses. In 1979, a court blocked Medicare from releasing such information after doctors fought to keep it secret. However, the court lifted the injunction in May 2013, freeing CMS to consider whether to release the data.
In turn, CMS asked for public comments about what it should do and received more than 130 responses. The Center for Effective Government was among the organizations that filed comments, calling for more transparency in Medicare spending and urging CMS to revoke its previous policy implementing the injunction. After considering those comments, CMS adopted its new policy.
The change may allow the public to examine the reimbursement amounts paid to medical providers under Medicare. Under the new approach, CMS will not release those records wholesale. Instead, the agency will wait for specific requests for the data and then evaluate each to consider if disclosure would invade personal privacy. While information about patients is clearly off-limits, it’s not clear what kind of information about doctors CMS will consider private, so it remains to be seen how much information is ultimately disclosed under the new policy. It should be noted, however, that the U.S. Supreme Court has held that businesses don’t have “personal privacy” under the Freedom of Information Act (FOIA), and the government already discloses the amounts it pays to other government contractors.
In all, the new policy is a very tentative step forward. Depending on how the agency evaluates requests, it could release lots of new information under the policy, or none at all. Moreover, before any information is released, members of the public will have to make requests under FOIA, which is frequently lengthy, tedious, and costly.
A better approach would be for CMS to post its spending data online, as the rest of the government does on USAspending.gov. In the new policy, CMS says it will release more aggregate data on Medicare spending, but doesn’t say which data or how detailed the information will be.
Meanwhile, Congress is also looking at the issue. In December 2013, House and Senate committees approved bills to modify Medicare’s payment rates, with broad bipartisan support. Both bills include open data requirements, directing CMS to publicly disclose payments on its website while protecting patients' privacy. Congress is expected to vote on the bills by the end of March.
Leslie Haymon contributed to this article.