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Viewpoint | Health Care Reform

Widening Gaps in the Wall Obscuring Physician Performance Differences

Arnold Milstein, MD, MPH1,2; Robert Kocher, MD3
[+] Author Affiliations
1Stanford's Clinical Excellence Research Center, Stanford University, Stanford, California
2Pacific Business Group on Health, San Francisco, California
3Venrock Partners, Menlo Park, California
JAMA Intern Med. 2014;174(6):839-840. doi:10.1001/jamainternmed.2014.1161.
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In response to a 2013 judicial decision lifting a 34-year-old injunction, the Centers for Medicare & Medicaid Services (CMS) recently announced that it will release patient-anonymized information about Medicare payments made to individually identified physicians. The only exception will be when the CMS determines that a physician’s right to privacy outweighs the public’s right to scrutinize federal information or the centers’ statutory obligations.

The judicial decision pivoted on enabling the public to assess CMS’s performance in preventing medical fraud. For example, release of information on payments would allow the public to identify physicians whom CMS paid for services rendered on a single day that would require more than 24 hours of a physician's time. However the original injunction had been broadly interpreted by CMS to prohibit release of any payment information pertaining to identifiable physicians. For this reason, the most important consequence of lifting it will be to strengthen the public's ability to assess the performance of individually identified physicians by analyzing Medicare's uniquely large payment database. CMS payment data encompasses demographic information such as patients’ age and sex, as well as diagnoses, testing, and treatment data recorded on bills from all Medicare providers. Such data enable comparisons of physicians’ utilization patterns, frequency of adherence to some clinical guidelines, and treatment consequences.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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