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.
—Jeremy Smerd