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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anoniBarry CarolPeterMatt Guldin Recent comment authors
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Recently, Texas said it was releasing worker’s comp data that listed physician data/costs… after days of navigating the website I had no luck.
I did discover there was a fee for CDs of the data, but did not really no who to make what out to, and I did discover a summary of the data which outlined the format of the tables.
Beyond that nada! tried calling- nada!
Effectively, for someone with my resources the information was carefully wrapped behind red tape.
–my experience makes me believe that this will be the case here as well

Barry Carol
Barry Carol

I agree with both Matt and Peter on this one. Hopefully, the court decision will be sustained and then applied to the rest of the country. Medicare payment rates for hospital procedures would also be a useful benchmark. We need to develop decent quality and performance metrics to evaluate doctors, hopefully, with plenty of input from the medical specialty societies. Primary care metrics are trickiest. However, I note that the UK’s NHS developed a list of 147 measures that it used to evaluate primary care doctors with meaningful bonuses going to those who performed best. Points were assigned to each… Read more »


Too bad we can’t get transparency from health insurers and hospitals on their charges and billing practices. Have you ever tried to ask your insurer how much you can expect to pay for a particular procedure? Ever tried to get the chargemaster information from a hospital – even a state run and subsidized one? Let’s pull the secrecy veil off the entire industry – not just doc performance.

Matt Guldin
Matt Guldin

This is a hugely underappreciated story and could potentially have major ramifications for the health care industry. The major problem is the health plans have had with physician profiling is that they just don’t have the numbers to make it statistically reliable enough. Even a dominant Blues plan might only account for 30 to 40 percent of a physician’s payer mix. Still, have at least 50 percent of the physician’s payer mix in that “black box.” That is the single biggest problem that the Bridges to Excellence (BTE) program has run into repeatedly. They were successful in enrolling large employers… Read more »