Medicare Claim Data Ordered Released

A judge’s order requiring the federal government to release information on the quality and cost of thousands of physicians could embolden employers to steer employees to better-performing doctors.

Consumers’ Checkbook, a consumer advocacy group in Washington, brought the lawsuit against the Department of Health and Human Services in hopes of making public every health care claim paid by Medicare. The consumer group initially sought the claims data through a Freedom of Information Act request in March 2006.

The information, which was scheduled to be made public September 21, will be the largest existing data set publicly available about the way doctors practice medicine as detailed by claims paid by Medicare. The group will use the data to measure the quality and efficiency of doctors and plans to launch a Web site that tells consumers how much experience doctors have performing certain procedures.

“This will make the efforts to rate doctors more reliable, more valid,” says Robert Krughoff, president of Consumers’ Checkbook.

The information could be a boon to employers and other groups looking for greater cost and quality transparency in the heath care marketplace.

“We have quite a bit of evidence that many patients have major complex procedures done by physicians that don’t have any experience at all,” Krughoff says. “This can help employees choose physicians for major procedures.”

Making the information public, he says, will encourage physicians to improve.

Though Health and Human Services was named as a defendant, experts believe the ruling, made by U.S. District Judge Emmet G. Sullivan in Washington, will not be appealed by the Bush administration. Last year, in an executive order, President Bush called for greater cost and quality transparency in the health care system, something that the release of this data will achieve, experts say.

“It honestly is a treasure trove,” says Francois de Brantes, the national coordinator for Bridges to Excellence, a program that rewards doctors for improving the quality of their medical care. “There is an unbelievable amount of analysis that can be done with the data that up until today just hasn’t been possible.”

Doctors have staunchly opposed the use of claims data to measure the way they practice medicine. The American Medical Association says Medicare data paints an inaccurate picture because it does not focus on whether a patient’s care led to recovery—only how much the care cost and what it consisted of.

“The AMA is concerned that the indiscriminate release of raw Medicare claims data has the potential to put patient privacy at risk and will paint an inaccurate and incomplete picture of the quality of physician care, misleading patients,” according to a statement by AMA board chair Dr. Edward Langston. “The risks and harm associated with the release of this information far outweigh any potential benefits.”

Consumer groups say the data has limitations but it nonetheless can be used to accurately rate physician quality.

The specificity of the data can paint an intimate portrait of a doctor’s practice, experts say. Without releasing patient information, the data can detail what kind of medicine a doctor prescribed and whether a patient experienced complications or died after surgery. The quality of the Medicare data is noteworthy as well, because it tracks a patient over a long period of time—from when they turn 65 until a patient’s death—when health care use is highest.

The information could eventually subject doctors to the twin consumer demands of high quality and low cost, says Paul Ginsburg, president of the Center for Studying Health System Change.

“This is significant,” he says.