Ruling orders disclosure of doctors’ data

The release of data on
individual patients was not part of the lawsuit.

LOS ANGELES TIMES

WASHINGTON — Whether it’s a hernia repair or heart bypass, doctors who perform a given operation more frequently get better results. The problem for patients has been determining who those physicians are before picking one.

Now a court ruling appears to open the way for consumer access to such information, potentially transforming the relationship between doctors and their patients, as well as the business of health care.

Last week, a federal judge in Washington ruled in favor of a consumer group that sued the Health and Human Services department to allow disclosure of specific data about doctors from the Medicare claims database. U.S. District Judge Emmet G. Sullivan concluded “a significant public benefit” could be served by releasing the data and ordered the department to turn it over by Sept. 21.

With information on more than 40 million patients and 700,000 doctors, the Medicare database is far richer than any private insurer’s. While it would not have information on some doctors, such as pediatricians, who don’t treat Medicare patients, it is considered the mother lode for data on those who treat adults, since Medicare recipients are a mainstay of most practices.

The database’s usefulness has been limited by a decades-old government policy that protects the privacy of doctors, who fear the information could be used to micromanage the practice of medicine. But as the cost of medical care has skyrocketed, employers, insurers and consumer groups have pressured the government to open Medicare’s files on individual doctors.

Benefits

Those files could reveal far more than how many times a year a surgeon performs a hip replacement operation. The data also could be analyzed to determine how individual doctors make critical decisions on tests and procedures that determine both quality and costs. They would show which doctors fail to order preventive tests that could catch disease early. And they could indicate which ones order duplicative tests or unnecessary hospitalizations.

“These data will make it possible to develop measures that will be very helpful to consumers,” said Robert Krughoff, president of Consumers’ Checkbook, the nonprofit group that sued for the information. “Someone who is thinking they need a knee replacement — or a prostatectomy — will be able to go on our Web site and see how many of these procedures their physician has done for Medicare patients.”

Consumers’ Checkbook, which compiles ratings of a wide range of service providers, sells its information to individual subscribers. But Krughoff said it intends to make the Medicare data available free of charge.

The lawsuit did not seek the release of data on individual patients.

Some business groups said the ruling could be a turning point in the quest to balance costs and quality, setting a precedent for the release of more detailed information.

“We’ve very excited that the court has ruled in this direction,” said Helen Darling, president of the National Business Group on Health, which represents big companies. “Large employers have been trying to make information available on performance to consumers and to those who make purchasing decisions on which providers might be in a preferred network.”

The Department of Health and Human Services has not decided whether to appeal the ruling. “We’re in the process of reviewing the court’s decision and evaluating our response,” spokeswoman Christina Pearson said .

An appeal could be politically embarrassing for the administration, since President Bush and HHS Secretary Michael Leavitt have campaigned for greater openness and consumer empowerment in health care.

“Not supporting this ruling would certainly be inconsistent with administration initiatives that favor price and quality transparency in health care,” said Paul Ginsburg, president of the Center for Studying Health System Change, a policy research group. “This represents transparency on the quality side.”

Moreover, support for opening the Medicare database is building in Congress. Two unlikely allies, Sen. Hillary Rodham Clinton, D-N.Y., and Sen. Judd Gregg, R-N.H., filed legislation this summer to make the data available to research organizations. Under current policies, researchers who use Medicare information cannot identify individual doctors.