Group Sued to Find Out About Procedures
By Christopher Lee
Washington Post Staff Writer
Saturday, September 1, 2007
Consumers may soon have more information to help them select a doctor when they need an operation or other serious medical procedure.
A recent federal court decision requires the government to make public Medicare claims information about individual doctors and the procedures they perform, a ruling that could spur development of online reference tools that help patients evaluate physicians based on the volume of procedures they do.
Studies show that physicians who perform a higher volume of certain medical procedures tend to achieve better outcomes than doctors who do them less frequently.
The ruling by U.S. District Judge Emmet G. Sullivan last week came in response to a lawsuit filed by Consumers' Checkbook/Center for the Study of Services, a District-based consumer group that charges a $24.95 fee for access to an online guide to top doctors around the country.
The court decision specifically concerns Medicare data for the District, Maryland, Virginia, Illinois and Washington state from 2004, but Robert Krughoff, president of Consumers' Checkbook, said his group has requested data for all states for 2005 and does not believe it will take another court fight to get it.
The group had sued the Department of Health and Human Services to release data on every physician claim paid by Medicare, the federal health insurance program for the elderly.
HHS officials argued that making such information public could violate doctors' privacy rights. Sullivan ruled, however, that the potential public benefit outweighed such concerns and ordered the data turned over to the group by Sept. 21 in accordance with the Freedom of Information Act, which guarantees the public's access to federal government records.
"Even if plaintiff . . . is only able to provide a partial measure of the overall quality of Medicare services, such a contribution would still be a significant public benefit considering the complexity and importance of the Medicare program," Sullivan wrote.
Medicare officials are reviewing the court decision before deciding whether to appeal, said Jeff Nelligan, a spokesman for the Centers for Medicare and Medicaid Services. President Bush and HHS Secretary Mike Leavitt have been forceful proponents of providing consumers with more information to help them make decisions about their health care. The Medicare Web site already contains data about hospital quality, for example.
The American Medical Association is also reviewing the decision, a spokeswoman said.
The data include information submitted to the Medicare agency by doctors seeking payment for services they have performed. While it could be used to determine how much income a physician derived from the Medicare program, Krughoff said his group's goal is to help consumers evaluate a doctor's skills.
By later this year, the group plans to create a reference tool on its Web site, http://www.checkbook.org, that will report the number and type of major procedures each physician performed for Medicare. The group will not have access to data that identifies individual Medicare patients.
"There are a lot of uses for the data to develop measures that will help consumers, help physicians and help the Medicare program itself," Krughoff said. "So we will be able to say for cardiac surgeons how many bypass cases they've done. And we'll be able to say for urologists how many prostatectomies they've done. . . . It's important that a doctor do at least some number of cases."
Such a database would have limitations. Procedures that doctors perform on non-Medicare patients would not show up, for instance. Krughoff said his group hopes to get procedure counts from private health plans into its database, and it will invite doctors to provide information about the total number of procedures they do.
Efforts by some private insurers to rate doctors on quality of care and cost efficiency have been criticized by physicians, who say the rating systems are imperfect, often contain errors and sometimes appear to be motivated by a desire to cut costs rather than to ensure that patients get the best care.
View all comments that have been posted about this article.