IMPACT: Bills to open Medicare data pick up another supporter in Senate

Introduction

Efforts to open Medicare billing records by doctors and other medical providers are gathering steam in the Senate. Sen. Dick Durbin, D-Ill., has introduced the third bill this session calling for a wide release Medicare billing data, a move vigorously opposed by the American Medical Association.

The Durbin bill, S-856, the Medicare Spending Transparency Act of 2011, differs from two bills introduced earlier this session by Sen. Charles Grassley, R-Iowa, and jointly by Grassley and Sen. Ron Wyden, D-Ore. Durbin’s bill would require Centers for Medicare & Medicaid Services to create on its website a list of Medicare service providers and suppliers and detailed aggregate data of their billing.

The bill would require CMS to publish the number of patients a doctor saw during the previous year, the average number of billing codes a doctor filed for each patient encounter, and how much they were paid by Medicare. It would also require CMS to publish the top 50 procedure billing codes each provider billed Medicare and the top 50 diagnosis and procedure code pairs they used. The bill would also make raw Medicare billing data available to “qualified individuals and groups.”

Public access to Medicare billing data would be a breakthrough for patients, said Rosemary Gibson, co-author of “The Treatment Trap,” a book critical of medical care overuse. “If you have someone living in a town and they see their hospital is the top hospital that bills for back surgery, they might think twice about if that hospital is performing unnecessary services,” Gibson said. “The data is out there and nobody is acting on it. The public is bearing the consequences.”

In a press release announcing the bill, Durbin noted investigations by the Center for Public Integrity and The Wall Street Journal, which have used a sampling of the data to produce a series of stories documenting waste, fraud and abuse in the Medicare system.

“While the federal government has stepped up fraud detection and enforcement, allowing nongovernmental groups access to data can also play a role in detecting fraud,” Durbin said. “My legislation would bring transparency to the Medicare program by providing basic information about how taxpayer dollars are being spent in order to shine a light on any abuse within the system.”

In 2009, the Center sued CMS for access to Medicare billing information. Partnering with The Wall Street Journal, the Center subsequently acquired a sampling of eight years of the data.

Both media outlets, however, agreed in the course of negotiations with CMS to refrain from identifying medical providers based on their Medicare billing; CMS insisted on the agreement before releasing the data, since releasing the data could have put the federal agency in violation of a court order.

In 1978, the American Medical Association successfully sued the federal government to bar the predecessor of HHS from releasing the amount of money Medicare pays individual doctors. The agency, and the news organizations, could face legal ramifications if they break that agreement. In their reporting on Medicare, both news organizations have relied on sources outside of the Medicare billing data to name doctors and other providers.

The AMA declined to comment on the Durbin bill, but it has strongly opposed efforts in Congress to make the data public and said releasing the data could increase fraud and put physicians at risk for identity theft.

Durbin spokeswoman Christina Mulka, however, said Durbin’s bill goes further than the previous bills to address the AMA’s concern about physician privacy because it “would only make summary level data available to the public.”

Along with Grassley’s first Medicare data bill, and the bill he co-sponsored with Wyden, Durbin’s bill has also been referred to the Senate Committee on Finance. Mulka said Durbin will likely consider signing on to the Grassley-Wyden bill after the recess.