House Bill on Medicare Payment Transparency Undermined by Poison Pill Provision

On March 14, the House passed the SGR Repeal and Medicare Provider Payment Modernization Act (H.R. 4015), which includes provisions on Medicare data transparency. Among other things, the bill would require Medicare to publicly disclose data on reimbursements made to physicians while protecting patients' privacy. The legislation would direct the Secretary of Health and Human Services to release payment data on Physician Compare, the Center for Medicare and Medicaid Services' online physician database. Unfortunately, the bill also contains a "poison pill" – the repeal of the Affordable Care Act's individual mandate – rendering it unworkable in its current form.

The positive provisions of H.R. 4015 would require payment data, previously kept largely confidential, to be published in an electronic, searchable format. This data would be incorporated into the preexisting Physician Compare website and would include information on the services furnished by physicians and submitted charges and payments for services. The database would be searchable by the specialty or type of the provider, characteristics of the services, and the location of the physician.

The bill's language grants access to data that benefits patients, ensuring they receive health care of the highest possible quality. Increased scrutiny could deter fraudsters, strengthen Medicare, and help ensure its ability to continue playing its vital role in securing health care for America's seniors. To guarantee the site fairly represents providers, the bill would allow physicians to correct data about their practices.

Access to most Medicare payment data has been embargoed since 1979 by an only recently lifted court injunction. At $555 billion in annual spending, Medicare is an ideal candidate for greater transparency, especially because increased public scrutiny can detect and deter fraud. In a study conducted by The Wall Street Journal and the Center for Public Integrity, the authors concluded that public reimbursement data could act as a substantial deterrent to fraud and waste. Open data would also help patients make decisions about doctors and treatments and improve overall health outcomes.

Because it includes yet another attempt by the House to repeal portions of the Affordable Care Act, the legislation will almost certainly be a non-starter in its current form. President Obama has vowed to veto the bill, and Senate passage is not likely. However, the House majority's campaign against the Affordable Care Act does not diminish the need for data transparency. Medicare payment data is an essential component of holding providers accountable and ensuring that beneficiaries receive the highest quality of care. We urge Congress to open Medicare's books, without political gimmicks.

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