HHS Appeals Decision That Requires Release Of Medicare Physician Claims Data

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Primary Care / General Practice;  Litigation / Medical Malpractice
Article Date: 22 Apr 2008 - 12:00 PDT

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HHS last week in the U.S. Court of Appeals for the District of Columbia filed an appeal of an August 2007 court decision that requires the department to release Medicare claims data on more than 40 million beneficiaries and 700,000 physicians, the Los Angeles Times reports (Alonso-Zaldivar, Los Angeles Times, 4/19).

In August 2007, the U.S. District Court for the District of Columbia ruled that HHS must release Medicare physician claims data for Illinois, Maryland, Virginia, Washington state and Washington, D.C. In the case, Consumers' CHECKBOOK/Center for the Study of Services filed a lawsuit to obtain access to the data. HHS argued that the release of the data would violate the privacy of physicians. However, the court rejected that argument because Medicare claims account for only a portion of the incomes of physicians. According to the court, the release of the data would "help the public make more informed Medicare decisions" and provide "more information of how government funds are spent."

Consumers' CHECKBOOK plans to post the data online for public use. Researchers could analyze the data to determine the number of times physicians perform certain procedures and to compare the mortality rates among patients of certain physicians, and health insurers could use the data to improve their analyses of physician quality (Kaiser Daily Health Policy Report, 8/27/07).

Consumer groups, employers and health insurers support the decision, and physician groups oppose the decision. The American Medical Association, which has petitioned to join the HHS appeal, maintains that the data could be misleading because they do not take into account differences in patients treated by different doctors, the Times reports.

Comments
In a statement, HHS officials endorsed the objectives of Consumers' CHECKBOOK but said the department sought clarification of the proper action to take in response to the August 2007 decision and a 1970s court decision that sought to protect the privacy of the financial information of physicians. HHS spokesperson Christina Pearson said, "We're caught between court decisions," adding, "There's conflicting information from different courts, so we're pushing to get clarity."

Robert Krughoff, president of Consumers' CHECKBOOK, said that the release of the data would remain consistent with efforts by the Bush administration to promote health care transparency. He added, "I know the government was under a lot of pressure from the AMA in particular, arguing that the government should appeal. Whether that's the reason the government appealed, I don't know" (Los Angeles Times, 4/19).

MD Quality Reporting Initiative
In related news, CMS on Friday announced new options designed to increase participation in the Physician Quality Reporting Initiative, CQ HealthBeat reports. Under one option, physicians could report quality data to a medical registry, which would submit the information to CMS. CMS said, "Participating eligible professionals can choose to report data on individual measures or groups of measures that capture a number of data elements about common care processes for diabetes, kidney disease and preventive medicine."

In addition, CMS will provide physicians with new reporting periods, provided that they report on groups of quality measures. "Participants may now start reporting in July 2008 and still be eligible to receive an incentive payment" in 2008, CMS said (Reichard, CQ HealthBeat, 4/18).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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