News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

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News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Experts predict employers will use this data to create “report cards” on individual physicians

In a big step forward for public access to data about provider outcomes, the Department of Health and Human Services (HHS) will make its enormous Medicare claims database more broadly available to the public. Both the press and the public will be able to search for information about individual physicians. It is likely that information about pathologists will be searchable in this manner.

Specifically, Medicare will relax its restrictions on the release of information about individual doctors who participate in Medicare. This development was reported recently by The Wall Street Journal, which played a role in getting HHS to make physician data available to the public.

“This is a giant step forward in making our health care system more transparent,” stated Marilyn Tavenner, Medicare’s Acting Administrator.

Tapping the Forbidden Mother Lode of Healthcare Information

The government agency’s data has been largely inaccessible because of a decades-old court injunction. That injunction was the result from a lawsuit jointly filed in 1979 by the American Medical Association (AMA) and the Florida Medical Association. The plaintiffs went to court to prevent the Carter administration from publishing a list of annual Medicare reimbursements, according to a story published by It was the AMA’s position that a public release of this Medicare information by the government would violate the privacy of doctors.

Employer Groups Welcome Access to Medicare Data on Providers

The most recent developments in this story started in January 2011. That is when Dow Jones & Company (DJ), publisher of The Wall Street Journal, filed court papers to overturn the injunction. Dow Jones asserted that the injunction from the 1979 court case blocked public access to records containing evidence of Medicare fraud and the doctors behind it. As a consequence, the company maintained, it barred The Wall Street Journal and other news organizations from fully investigating and exposing abuses in the $500 billion system.”

Last month, the Department of Health and Human Services (HHS) announced that it would open its Medicare data to the public. Acting Medicare Administrator Marilyn Tavenner discussed these developments at a press conference. It will be the first time that the public will have access to Medicare data by individual provider, such as hospital or physician. (Photo copyright

The decision by HHS to provide public access to this data is consistent with the trend toward increased transparency in provider outcomes and provider pricing. Dark Daily has predicted that the Medicare program will eventually open data about clinical laboratory test providers and pathology group practices as part of this policy.

The goal of the new rule is to give access to Medicare’s extensive claim database to employers, insurance companies, and consumer groups. It allows them to use the data to make comparisons in order to produce report cards on local doctors and hospitals, an Associated Press article (STLT) stated. Compiled in an easily understood format and released to the public, medical report cards could become a powerful tool for promoting quality care.

“There is pent-up demand for this data because everyone wants to be a more informed, intelligent [healthcare] consumer,” declared Maria Ghazal, Policy Director at the Business Roundtable (BRT), in the STLT piece. The Business Roundtable represents CEOs of major companies providing health benefits coverage to some 35 million employees, retirees, and family members.

Medicare’s database is the mother lode of health care information, noted the AP writer. It contains claims information on 47 million beneficiaries. Virtually every doctor and hospital in the country participates in the Medicare program.

By analyzing masses of billing records, experts can now glean such critical information as how often a doctor has performed a particular procedure and get a general sense of problems, such as preventable complications, STLT reported.

“There is tremendous variation in how well doctors do, and most of us as patients make our choices blind,” added David Lansky, President, Pacific Business Group on Health. His nonprofit group represents 50 large employers that provide health benefits coverage for more than 3 million people.

Lansky also pointed out that early efforts to rate physicians used limited private insurance data that focused on primary care doctors. He expects that Medicare’s rich information could provide the data to start rating specialists as well.

A Medicare spokesperson has announced that consumers will see the first performance reports by late 2012. In the short term, the biggest user of this data may be employers. One use for this data will be to analyze physician performance as a company prepares the annual revenue and update to its health benefits program. It is also expected that employers will want to put report cards on physician performance directly in the hands of their employees.

In response to the Dow Jones lawsuit and new healthcare trends, physician groups that fought for years against releasing the Medicare data shifted their position on the public release of information about individual physicians. Their strategy was to put conditions on the use of the information.

According to the WSJ story, the AMA said it supported the use of physician data “when it improves quality of care for patients.” However, the group expressed continued concern that easing some requirements for access to Medicare data “could result in the distribution of physician performance reports that are inaccurate and not meaningful for patients or physicians.”

The new rule gives individual providers the right to see their information before it is publicly released, and 60 days to challenge it.

The new Medicare move confirms the trend toward transparency as a tool for reining in costs and improving quality. Dark Daily readers will recall our recent story about the collaboration of four of the nation’s five biggest health insurance companies regarding their medical claims data. These four insurers are putting their medical claims data for billions of transactions into a single database for healthcare cost and utilization research. (See Dark Daily, “Aetna, Humana, Kaiser, UnitedHealth Put Five Billion Medical Claims into Database for Healthcare Cost, Utilization Research”).

It is a big deal that the Department of Health and Human Services will open Medicare data to the public. This directly reflects changes in society and the interest of informed patients to know more about the quality of healthcare services that are provided by hospitals and physicians in their community. Clinical laboratory managers and pathologists should expect that, at some point, relevant data about the services they provide to Medicare patients will be searchable by researchers and the public.


—Pamela Scherer McLeod

Related Information

Access to Widen on Medicare Data  

Medicare database to be available for comparisons

Senators Push for Public Access to Medicare Claims Database

Aetna, Humana, Kaiser, UnitedHealth Put Five Billion Medical Claims into Database for Healthcare Cost, Utilization Research

Wall Street Journal Sues to Open Up Secret Medicare Database

Policy shift will allow ratings for doctors

THE DARK REPORT: Medicare and Private Payers Ready To Implement Value-Based Payment