Safeguards, Protections Must Accompany Release of Medicare Physician Claims Data, Say AAFP, Others

September 10, 2013 04:57 pm News Staff

The AAFP and other physician-led organizations are urging CMS to apply a number of protections before potentially releasing individual Medicare physician claims data. These protections should help ensure that claims data are used fairly and accurately and in a way that promotes improvements in the nation's health care system, say the organizations.

[Stethoscope on top of medical claim form]

In a Sept. 5 letter(8 page PDF), the AAFP, the AMA and dozens of other physician-led organizations urge CMS to partner with physicians to develop policies on the release of individual physician claims data. "Our goal is to promote efforts focused on improving the quality of patient care while safeguarding against potential abuses that could negatively impact health care outcomes or diminish the privacy of Medicare physicians and patients," says the letter.

"Given the potential for security breaches, hackers, or efforts to re-identify information, we urge CMS to consider the potential impact of any data release on patient privacy and engage with experienced data statisticians, physician organizations and other relevant stakeholders on ways to further protect such data."

The AAFP and the other organizations are calling for steps to "ensure that the release of data does not mislead the public into making inappropriate and potentially harmful health care treatment decisions."

"Individual Medicare payment information should be presented together with quality (i.e., clinical) information, encouraging and facilitating value-based decision-making by consumers. If quality information is not available, cost and price information should be presented in a context that raises the importance of considering quality in decisions about providers, treatments and health care services."

In the letter, the organizations underscore their support for efforts to increase the quality of care and efficient use of resources in health care delivery, and they acknowledge that "greater access to Medicare data may be necessary to expand new delivery models and transform the existing payment system."

"Consequently, we urge CMS to engage with physicians and focus on care quality given that obstacles to this data may be blocking improvements to our health care system."

However, the groups also point out that "If not approached thoughtfully, release of individual physician payment data to anyone for any purpose can have unintentional, adverse consequences for patients, providers, and the health care system. For any data release program, safeguards must be in place to ensure that neither false nor misleading conclusions are derived from this information."

The groups ask CMS to

  • focus on efforts to improve health care quality;
  • ensure data are accurate by educating those accessing the information;
  • allow physicians to review and correct any errors; and
  • follow existing safeguards, including appropriate risk-adjustment and attribution methods, for any public reports that use the information.

"Raw Medicare claims data is a crude metric for assessing the quality of medical care," says the letter. "When used in isolation, this data ignores the more important clinical factors that affect patients, including case mix, comorbidities, and other patient characteristics. These deficiencies are exacerbated by the fact that Medicare claims constitute only a portion of services performed by many physicians.

"For these reasons, we discourage public reporting of claims data without any relevant quality information or the inclusion of other payer sources. CMS must safeguard attempts to mischaracterize the data or emphasize volume as an indicator of quality."