Is doc-specific data next?

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

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