Release of Medicare data could help reform health-care system

By Michael O. Leavitt and Robert Krughoff
Friday, March 19, 2010; A23

During the past year's contentious debate over health-care reform, obscure policy differences have received far more attention than areas of agreement. The focus should have been discussion of how our society can get the most value for the dollars it spends on health care.

Meanwhile, an escalating federal court battle in which we were on opposite sides could have a major impact on just that. In 2006, the nonprofit organization Consumers' Checkbook/Center for the Study of Services -- which one of us leads -- brought a Freedom of Information Act lawsuit against the secretary of health and human services -- a position the other of us held -- for access to information from claims filed by physicians for each procedure or service rendered to Medicare beneficiaries. There is no question that patient privacy would be protected in such releases.

Though it supported wide use of Medicare data, the Department of Health and Human Services opposed the release of this information based on its interpretation of its legal duty to protect physician privacy. After a U.S. District Court judge sided with Checkbook, the department appealed. When the government won that round, Checkbook sought review by the Supreme Court. The justices are expected to decide soon whether to take the case.

Despite our positions in this case, our understanding of the U.S. health-care system compels us to speak out. The release of Medicare data could have a powerful effect on the quality and cost of U.S. health care. Provisions requiring such a release have been included in various pieces of legislation that Republicans and Democrats have introduced in recent years. The Senate health-reform bill is just the most current example. Whatever our individual views on comprehensive health-care legislation, we agree that Congress should find some vehicle to pass such a transformative provision.

Releasing these physician-identified claims data (which, again, protect patient privacy) would make it possible for independent organizations -- including regional consumer, employer and provider health-care coalitions; government agencies; consumer organizations; and researchers -- to develop and produce rigorous measures and reports on the performance of physicians, medical groups and other providers, free of political or provider pressure.

Such reports could help consumers find the best providers, as well as give such providers public recognition; help public and private health insurers create rewards and other incentives for all providers to improve; and help reduce claims fraud.

Specifically, these reports could identify physicians who consistently ensure that their patients get the tests and treatments called for by evidence-based guidelines. The need to measure and improve on this front has been extensively documented. One widely cited 2003 New England Journal of Medicine study found that fewer than 60 percent of patients with a broad range of conditions received the recommended care.

Reports using these data could help identify physicians who consistently have better or worse risk-adjusted rates of patient death and complications in high-risk procedures.

For patients who need procedures in which the doctor's experience matters, reports based on the data would make it possible to know which doctors have appropriate levels of experience.

The data could make it possible to recognize and reward physicians who prescribe and deliver relatively low numbers of unnecessary or inappropriate procedures and services. Extensive research has shown that use of health-care resources is twice as high in some communities as in others without any significant difference in patient outcomes.

In addition, the data can be used to identify fraud, such as the tens of millions of dollars in claims that have been filed by "doctors" who are dead.

Reports based on the data will require skilled, rigorous analysis, with the methods fully documented and subjected to public scrutiny. Efforts to prepare such reports using data from other sources are ongoing, but the Medicare data would make much better reports possible.

Others that support releasing these data include AARP, Consumers Union, the AFL-CIO, the National Business Group on Health, Pacific Business Group on Health and the Business Roundtable.

One way or another, Congress needs to make this happen.

Michael O. Leavitt was secretary of health and human services from 2005 to 2009. Robert Krughoff is president of Consumers' Checkbook/Center for the Study of Services.

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