Medicare Increases Transparency Stakes

Physicians are already preparing for the impact of high deductibles and patient shopping, and now must also be aware that Medicare may begin releasing information about payments made to individual physicians (if requested under the Freedom of Information Act [FOIA]).

Under the policy published January 17, 2014, in the Federal Register and scheduled to take effect March 17, the Centers for Medicare & Medicaid Services (CMS) will determine whether or not to release information on a case-by-case basis. In its determination, CMS will use a “balancing test” which weighs the balance between the privacy interest of the physician and the public disclosure of information.

While this overturns the precedent set by CMS in November 1980 – that public interest in individual physician payments was not sufficient to compel the disclosure of such information – this change of direction is consistent with other industry efforts to improve transparency and access to data so that consumers can make informed choices.

While some argue that this is in the public’s best interest, PYA and other organizations, such as the American Medical Association and the American College of Physicians, are concerned that the data can be misleading and misinterpreted.  For instance, claims payment information alone does not reflect the entire picture since it does not address factors such as location, payer mix, patient social and economic demographics, and practice costs.

While it is likely that payment information would be released in the aggregate to protect patient privacy, physicians should consider the ways that this information might be used and the potential impact on day-to-day operations.  Examples might include:

  • Patient inquiries to compare charges and available self-pay options for certain services as they prepare to pay out-of-pocket.
  • Online tools from Medicare, private insurance companies, and public websites that allow patients to see their provider’s credentials and any sanctions; compare how often the provider performs procedures compared to others in the same specialty; research which medications (name, class, brand name vs. generic) their provider prescribes; identify referral patterns between providers, etc.
  • Patient-originated sites that allow patients to rate their provider in terms of ease of appointment access, customer service of staff and providers, and [perceived] quality of the patient experience.

While the day-to-day impact may be slow in building, physicians should prepare for the unexpected and train themselves and their staff with talking points to address questions that patients may raise.  Additionally, physicians should vigilantly monitor themselves on the Internet to see what is available to the public—both individually and their practice as a whole.  For more information about how your practice can address the changing culture of transparency, contact the experts listed below at PYA, (800) 270-9629.


Lori Foley

Lori Foley

Principal

Allison Wilson

Allison Wilson

Manager

Related Posts
An article by PYA Principal W. Lyle Oelrich was recently published by Becker’s Hospital Review. “10 Physician Compensation Statistics: How Does Your Organization Measure Up?” provides a list of statistics...
Read More

“10 Physician Compensation Statistics: How Does Your Organization Measure Up?”

Becker’s Hospital Review recently published an article by PYA Consulting Manager Kathryn Culver. The article, “The Conflict Between Post-Acquisition Compensation and the Value of Your Medical Practice,” explores the inverse...
Read More

The Conflict Between Post-Acquisition Compensation and the Value of Your Medical Practice

The Tax Cuts and Jobs Act (TCJA) of 2017 brings sweeping changes for many businesses. Along with a reduced corporate tax rate and the elimination of the Alternative Minimum Tax...
Read More

Looking Ahead: Net Operating Loss Rules under the New Tax Act

Businesses are increasingly reliant on technology to achieve organizational objectives. However, with the convenience and efficiency of technology come intensifying risks of data loss and theft. High-profile data breaches top...
Read More

Cybersecurity Framework “SOCs” It to Cyber Threats

Engage. Share. Encourage. The American Healthcare Lawyers Association (AHLA) is hosting AHLA Day April 19, 2018, and these impactful words are setting the tone. AHLA receptions will be held across...
Read More

Join PYA in Celebrating Our Health Lawyer Colleagues During AHLA Day

PYA has released a white paper that discusses the importance of the AICPA’s cybersecurity risk management framework and System and Organization Controls for Cybersecurity in assessing the strength and effectiveness...
Read More

New PYA White Paper: Framework Offers Companies Solution for Cybersecurity Risk

PYA has added 2018 reimbursement updates to a white paper that provides valuation guidance to hospitals considering telemedicine arrangements for providing much-needed healthcare services at lower costs. As patient demand...
Read More

PYA White Paper “An Introduction to Valuing Telemedicine” Gets 2018 Updates

Compliance Today magazine recently published an article, “Regulatory Compliance: Physician Needs Assessments Are an Integral Step,” authored by PYA Principal Tynan O. Kugler. It highlights the critical role physician needs...
Read More

Regulatory Compliance: Physician Needs Assessments Are an Integral Step

Medicare cards are getting a much-needed facelift.  The Centers for Medicare & Medicaid Services has announced its intention to remove Social Security numbers from the cards in an effort to...
Read More
Medicare card scam

New Medicare Cards in the Mail—Don’t Fall Prey to Scammers

Share This Insight

If you received value from this article, please share it with your network (e.g., Facebook, Twitter, LinkedIn). Icons below for your convenience.

Stay Current

* indicates required
Monthly eNewsletters
See more newsletter and alert options.

PYA Population Health Ascend

PYA Healthcare Blog

PYA Thought Leadership Services

The Healthcare Loop