Another Step Toward Transparency — Brian Klepper

It was the great economist Adam Smith who said that, for markets to work, they need (among other things) "perfect information." Health care hasn’t worked, in large measure, because its markets have had almost no information.

So in what could be a huge step forward for the health care transparency movement, a federal court has ruled that the public interest outweighs concerns about physician privacy, and that, next month, CMS should release to a consumer advocacy group the Medicare data sets for 4 states and the District of Columbia. Here’s a snippet from Saturday’s Wall Street Journal article (subscription required):

The data at issue include medical-procedure and
billing details that physicians send to Medicare to get reimbursed by
the federal insurance program for the elderly and disabled. Although
collected largely for billing and administrative purposes, the data
could be analyzed to see how often a doctor performs a given procedure
and even to compare mortality rates among patients of different doctors.

The government has until Sept. 21 to release the data,
covering Maryland, Illinois, Washington state, Virginia and Washington
D.C., to the nonprofit Consumer’s CHECKBOOK/Center for the Study of
Services. The group said it will set up a free database on its Web site
for public use. It has filed similar public-information requests for
Medicare claims data for all 50 states.

It’s worth noting that this Administration, which has prided itself on its advocacy for EMRs, transparency, RHIOs and all the rest of it, when it counted, sided with keeping doctor performance secret. When the chips were down, this is how it actually worked.

You can bet that analytical groups all over the country will pounce on this information, profile and post the performance of physicians in these states, and campaign for access to the rest of the data.

Until recently, despite a lot of very worthwhile effort, data that could be used to develop performance information have been scarce. Health plans, who had the largest health care data sets, weren’t forthcoming with them. Now they’re publishing pricing data, which are somewhat useful, but not as useful as some of the other information embedded in their repositories.

The importance of this case can’t be overstated. The release of the Medicare data, if it happens, will go far toward making physician performance data more available and commonplace. This is a major victory for health care reformers, and many thanks go to Consumer’s CHECKBOOK, the advocacy group that sued for the data. It’s still too early to break open the champagne, of course, because the powers that oppose transparency still have a month to get the decision reversed.

Read the court’s opinion here, and CHECKBOOK’s press release here. This is just one more brick in the wall, of course. But there’s steady progress. It’s happening. And everything will eventually change in health care as a result.

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