Is doc-spe­cific data next?

Rul­ing could pave way for re­lease of physi­cians’ Medi­care claims in­for­ma­tion

Modern Healthcare - - THE WEEK IN HEALTHCARE - Joe Carl­son

For decades, the CMS has kept se­cret its records on Medi­care claims pay­ments to in­di­vid­ual physi­cians. But Jus­tice Depart­ment state­ments in a re­cent law­suit and the first-ever re­leases of other provider charge data this year sug­gest the fed­eral govern­ment’s po­si­tion on keep­ing doc­tor-spe­cific in­for­ma­tion se­cret may be chang­ing.

Pro­po­nents of re­leas­ing the data say it could help iden­tify pat­terns of waste and fraud and help pa­tients and in­sur­ance com­pa­nies find doc­tors who de­liver the most ef­fi­cient and high­est qual­ity care. But med­i­cal groups have suc­cess­fully fought to keep the pay­ment in­for­ma­tion se­cret, say­ing it would vi­o­late physi­cians’ pri­vacy rights to dis­close their Medi­care claims data.

The Amer­i­can Med­i­cal As­so­ci­a­tion de­clined mul­ti­ple re­quests for an in­ter­view, while the Florida Med­i­cal As­so­ci­a­tion said it re­mains con­cerned that the data would be mis­used by the pub­lic. The two or­ga­ni­za­tions were co-plain­tiffs in a law­suit more than three decades ago that re­sulted in a per­ma­nent in­junc­tion pre­vent­ing the re­lease of physi-

“This is an im­por­tant mile­stone among many that are tak­ing place in this march to­ward open health­care data.”

—Andy Krackov Cal­i­for­nia Health­Care Foun­da­tion

cian-spe­cific Medi­care data.

That all changed May 31 when a U.S. Dis­trict Court judge in Jack­sonville, Fla., dis­solved the 1979 pro­hi­bi­tion. That de­ci­sion is chang­ing the cal­cu­lus for the Obama ad­min­is­tra­tion, which re­cently re­leased hos­pi­tal-spe­cific Medi­care charges and other data that pre­vi­ously were kept se­cret.

“This is an im­por­tant mile­stone among many that are tak­ing place in this march to­ward open health­care data,” said Andy Krackov, a se­nior pro­gram of­fi­cer with the Cal­i­for­nia Health­Care Foun­da­tion and a mem­ber of the ex­ec­u­tive com­mit­tee of the Health Data Con­sor­tium, an ad­vo­cacy group for open health data. “There is no ques­tion that the fed­eral govern­ment has been a ma­jor leader in the push for open health data.”

Whether the CMS ul­ti­mately will do a mas­sive data dump that doc­u­ments ev­ery dol­lar that doc­tors earn from Medi­care, along with di­ag­no­sis codes and pa­tient out­comes, re­mains to be seen. The CMS is well aware of the vig­or­ous pri­vate-sec­tor ef­forts to pry the data out of govern­ment com­put­ers. But of­fi­cials won’t say what their plans are.

Af­ter years of fight­ing for ac­cess to the files, ex­perts say re­lease of physi­cian-spe­cific data seems tan­ta­liz­ingly close at hand.

“The world has changed so dra­mat­i­cally in

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