Government Compelled to Share Medicare Claims Data
A ruling from the United States District Court will require that Medicare publicly share information detailing claims. Data covered by the decision will include information about procedures completed by clinicians.
The decision came down following a suit filed by the Consumers’ Checkbook/ Center for the Study of Services. The group filed a lawsuit against the Department of Health and Human Services, requesting information on all doctor claims paid out by Medicare.
That company is based in Washington, D.C. and provides direct information to consumers, including an online guide to physicians around the U.S. Checkbook plans to use information from the claims data to compile information about how frequently physicians perform different procedures. They hope to expand the amount of data available by procuring data from private health plans.
The judge, Emmet G. Sullivan, ordered that the information should be shared, citing the Freedom of Information Act as the relevant precedent according to a report from the LA Times. The Act guarantees access to federal government records for the public. Records are expected to be released by September 21st. The decision issued by Judge Sullivan concerns claims data collected from Maryland, Washington, Virginia, Illinois, and Washington, D.C. during 2004. However, the organization also requested complete data, across all states, from 2005. Data will detail physicians claims for reimbursement from Medicare for services performed.
The Judge stated that benefits provided by sharing such were greater than potential concerns about physicians’ right to privacy. Judge Sullivan cited this as an opportunity to improve the Medicare program overall. This will provide an opportunity to evaluate the number of procedures that different physicians perform. Federal officials, including President Bush and the Secretary of HHS Mike Leavitt, have been advocating for increased information available for patients.
Other organizations, such as the American Medical Association, have staunchly opposed release of this data. One concern cites efforts to oversee medical practice, intruding on clinicians. Some doctors cite worries that the data will not be accurately relayed to consumers, by failing to account for the wide variability of those treated.
According to an article in the Washington Post, the availability of this data may further expand the information that consumers have access to when choosing a healthcare provider to perform surgery and other procedures. Access to this data may further foster efforts to create reference tools available online.
Data included in this effort will only describe efforts completed by clinicians that were paid for by Medicare. This, then, will not describe those procedures completed through private health insurance payors, Medicaid, or the uninsured. So preliminary assessments provided, such as the one planned by Consumers’ Checkbook, may be limited in their scope.
Nevertheless, the Medicare system includes 700,000 physicians across the United States. And over 40 million Americans carry Medicare health insurance coverage. This decision likely represents a significant step forward in the effort to increase healthcare transparency.
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September 4, 2007 Related topics: Legal & legislative, Trends, Quality, Safety, Errors