Thread: Senate Bill to Put Physician's Medicare Billing Data Online

Senate Bill to Put Physician's Medicare Billing Data Online
Robert Lowes

April 9, 2011 - How much individual physicians receive from Medicare for treating seniors on a service-by-service basis — level-4 office visits, vaccinations, chest x-rays — would be posted online for all to see under a bill introduced April 7 by Sen. Charles Grassley (R-IA) and Sen. Ron Wyden (D-OR).

The 2 senators contend that public disclosure of billing information would help citizens and consumer watchdog groups spot Medicare fraud, waste, and abuse — and also deter clinicians from engaging in it.

"I believe transparency in the healthcare system leads to greater accountability," Sen. Grassley said on the Senate floor. "I’ve often quoted Justice Brandeis, who said, 'Sunlight is the best disinfectant.'" Accordingly, he and Wyden titled their legislation the Medicare Data Access for Transparency and Accountability Act.

The American Medical Association (AMA) counters that physicians deserve privacy when it comes to Medicare billing. Furthermore, it argues, government entities charged with combating Medicare fraud, such as the Department of Justice and the Office of Inspector General of the Department of Health and Human Services, already have access to the data. The plan to post a physician’s National Provider Identifier number along with the billing information could "put physicians at significant risk of identity theft," said J. James Rohack, MD, the AMA's immediate past president.

The proposed government Web site would contain Medicare billing data for all providers and suppliers, not just physicians. The Senate legislation requires it to be searchable, including on the basis of individual items and services. The public could access the site free of charge.

The legislation comes in the wake of a series of stories published last year by the Wall Street Journal based on an analysis of a limited amount of Medicare billing data. The stories spotlighted a number of physicians who received more than a $1 million a year from Medicare by performing an unusually high number of diagnostic tests and surgeries for seniors.

Sen. Grassley acknowledges that sheer volume for a particular service does not necessarily mean a physician is engaged in shady business. Rather, he or she may be a leader in that field, attracting more patients as a result. His legislation requires the billing-data Web site to state upfront that the information does not reflect on the quality of the service or the clinician who provides it.

The controversy over public disclosure of Medicare billing information goes back to the late 1970s, when the old Department of Health, Education, and Welfare sought to publish a list of all clinicians who treated Medicare patients and what they earned from it. The Florida Medical Association and the AMA asked a federal district court in Florida to issue an injunction blocking publication of the list, and the court obliged in 1979.

Dow Jones, the publisher of the Wall Street Journal, filed suit in that same federal court in January and asked it to lift the injunction. The case is pending.

Originally Posted by phosphor

I believe the difference is that it would be public information for "all to see", as Lam's post suggests. Haven't cross checked anything on it though.

You are correct, it makes it public knowledge. Joe Blow could see how many claims a doctor submits to medicare. But what good is that? The data itself is completely useless to anyone not familiar with how heathcare is run.


For instance, socioeconomics is the most accurate predictor of the amount of total medicare claims submitted by a provider and/or physician. Rural hospitals, especially rural critical access hospitals, bill medicare the most, because the population is usually poor, hence more patients in that area are on medicare and medicaid. Critical access hospital care is almost always of lower quality care due to the amount of money, or lack of money, that the hospital as to devote to newer technologies and staff. So the people with good insurance go to better hospitals who submit for fewer medicare claims per patient. The smaller critical access hospitals submit more claims, because the patients who can't afford drive out of town for a test settle with what it availble to them locally.

Now, how much of the general population would even consider this when looking up a physician's claim history? This bill tried to trick people into believing they could pinpoint physicians who fraud medicare by submitting claims for test and procedures that were not done /and/or unnecessary. This is untrue. HIPAA protects EMR records. A person could look up the volume of claims submitted, but they wouldn't know which claims are theirs.

So, a person can look up the volume of claims submitted, but that piece of information alone is useless. You would have to dig far deeper and evaluate each patient's medical history to determine if fraud is being committed. Joe Blow doesn't have that ability.

So, again, I say that this bill is completely useless. The Government knows it is useless. Medicare knows it is useless. The AMA fights it, because they know that this is just a way for the government to try and make it look like the physicians are the bad guys. The truth is, Medicare is a broken system on every level. Everyone shares the blame.