Consumer Group, AMA Battle Over Medicare Data

HHS will have to release data on every physician claim paid by Medicare as a result of a lawsuit brought by Consumers' Checkbook/Center for the Study of Services, or CSS.

Checkbook/CSS won a freedom of information lawsuit (23-page PDF; About PDFs) against HHS in August that requires the agency to disclose data on every physician claim paid by Medicare to Checkbook/CSS. The U.S. District Court for the District of Columbia initially ordered HHS to release the data on Sept. 21, but gave the agency more time to decide whether it wants to appeal the decision, pushing the release date to Oct. 22. It is not clear whether the government will appeal the decision.

Robert Krughoff, president of Checkbook/CSS, said the court's decision would be "good for consumers and physicians."

"It will help consumers make wise, informed choices among health care providers," said Krughoff in an interview with AAFP News Now. "For physicians, it is one additional resource that can be used to develop measures that give physicians feedback on how well they are doing. Many physicians are very interested in getting that kind of feedback so they can improve."

"We believe in transparency," said AAFP President Jim King, M.D., of Selmer, Tenn. "We want the public to know what we can do and what we do because we feel like we provide quality health care."

However, King added, "partial data can be misleading" and can be "taken out of context and misused to prove a person is or isn't competent. That would be (the AAFP's) major concern with this" decision, he said.

The AMA has the same concerns and has come out as vehemently opposed to the court's decision. In a letter to HHS Secretary Michael Leavitt, the AMA's EVP Michael Maves, M.D., wrote that the Checkbook decision "would allow for the indiscriminate release of raw Medicare claims data."

"The risks and harm associated with the release of this information far outweigh any potential benefits. We strongly urge HHS to appeal the decision," he said.

Maves said the ruling "has serious privacy implications for patients and their treating physicians by allowing for the release of information identifying individual physicians each time they perform a particular service or procedure. It would permit the unregulated, unqualified distribution of sensitive health data to any person or entity without regard to public interest, scientific integrity or a demonstrated ability to protect patient health information," Maves wrote.

The ruling requires HHS to release physician-identified claims data that include information about diagnoses and provided services, but it does not include any patient identifiers, thereby protecting patient confidentiality, argued Krughoff. But Maves said that "even with de-identified data, there remains a risk of deducing patient identity through combinations of variables, such as the name of the treating physician, diagnosis and date of service."

"This is of particular concern where data may be quite limited in smaller health care markets or in situations where a physician treats relatively few Medicare patients or performs a procedure on a patient with a rare disease," said Maves.

He also decried the fact that the Medicare data is not risk-adjusted, meaning it does not take into account factors that could affect outcomes, such as patient clinical outcomes, patient adherence to treatments and patient sociodemographics.

"Without adequate adjustment, the resulting measures would be inaccurate representations of physician performance, leading to conclusions of questionable validity as well as possible unintended consequences," Maves said.

Krughoff dismissed the AMA's concerns, saying that anyone who does not use the data responsibly risks the "loss of their reputation and possibly more."

Consumers' Checkbook plans to post the Medicare data on the Internet. "We would like to have a Web site that would tell people what the evidence is for a volume outcome relationship," said Krughoff. In addition, the Web site would enable consumers to identify or confirm that a physician has an appropriate level of experience, he said.