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Life Health > Health Insurance > Medicare Planning

Wyden: Let doctors see Medicare claim records

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Sen. Ron Wyden (D-OR) argued today that opening up the Medicare claims database could be one way to help doctors do a better job of coordinating care and reducing the cost of care.

Wyden promoted a Medicare database openness proposal he and Sen. Charles Grassley (R-IA), have developed at a Medicare physician payment hearing organized by the Senate Finance Committee.

The committee convened the hearing, which was streamed live on the Web, to talk about efforts to repeal the “sustainable growth rate” (SGR) Medicare physician payment law.

Lawmakers enacted the SGR law in 1997, in an effort to tie increases in the Medicare physician pay rates to growth in the U.S. gross domestic product (GDP). Since then, physician fees have increased much more quickly than GDP, and Congress has stepped in every year to keep the SGR fee-setting system from taking effect.

If Congress fails to block the SGR law by Jan. 1, 2014, then the Medicare physician reimbursement rate would drop about 25 percent.

Both Sen. Max Baucus (D-MT), the chairman of the committee, and Sen. Orrin Hatch (R-UT), the highest ranking Republican, said they would like to repeal the SGR system. They noted that the Congressional Budget Office has cut its estimate of the cost of SGR repeal in half, to $139 billion.

“If Congress doesn’t act now, when will we find a path forward?” Hatch asked.

Lawmakers said SGR repeal should be combined with efforts to reform the way Medicare pays physicians.

Wyden said that one major obstacle to physician efforts to coordinate and increase the efficiency of care is the physicians’ lack of access to information about Medicare claims.

“Providers have to know what they’re doing,” Wyden said. 

Wyden asked Jonathan Blum, the acting director of the Center for Medicare, the Centers for Medicare & Medicaid Services (CMS) that runs Medicare, to tell him by the end of the week when providers will have access to their Medicare claims data.

“We agree that, when providers can see their claims, that’s powerful,” Blum said.

Blum said the physicians who participate in Medicare accountable care organization (ACO) programs already get access to the data by signing confidentiality agreements.

CMS has found that, in the real world, one problem is that many physicians lack the technical resources to handle raw CMS claims data, Blum said.

Before CMS can create a useful physician claims data access program, it needs to come up with a system for producing physician-friendly claim data summaries, Blum said.

Another challenge with giving physicians access to “real-time” claims data is that federal law gives physicians up to 12 months to submit claims for Medicare services rendered, Blum said.

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