March 14, 2011
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Center for Healthcare Research & Transformation
Despite the “Strum und Drang” over health care reform in Congress these days, there is actually some interesting bipartisan activity occurring. While the stridency on health care reform often gets the most notice, the bipartisan activity offers some hope that challenging problems can move forward in a constructive way.
Not surprisingly, this activity is taking place principally in the Senate and between two senators who have worked together and on health care for a long time: Ron Wyden, Democrat of Oregon, and Charles Grassley, Republican of Iowa. They are sometimes joined by Scott Brown, Republican of Massachusetts. Wyden, Grassley and Brown came together over the proposal embraced by President Obama to accelerate the time line to permit state flexibility in health care reform. Now, Senators Wyden and Grassley are both interested in bills that would require transparency of Medicare provider data: a very good idea.
Medicare has one of the largest health care databases in the country: a true treasure trove of information for health care researchers and others. Senator Grassley says he was inspired to introduce the idea of more transparency of Medicare data after the Wall Street Journal and Center for Public Integrity sued and were given limited access to Medicare data. The suit was necessary because of a 1979 injunction that prohibited the federal government from releasing financial information about physicians. The injunction resulted from a legal challenge mounted by the Florida Medical Association to stop the Carter administration from publishing Medicare related physician earnings.
As a result of the data mining that was done from the limited information received by the Wall Street Journal, suspected gaming of Medicare was identified and some possible fraud exposed. Indeed, one physical therapist whose data was reported by the Journal has now been indicted for fraud.
The American Medical Association argues that this information should be kept confidential because physicians have a right to keep their financial information private. But, why would this be so when they are receiving funding from the federal government? After all, the request is not to release all data on physician incomes: only on the amount provided by Medicare. Salaries for teachers and public employees of all kinds and levels are routinely made public. If the AMA’s argument about right to privacy holds any water, why wouldn’t that same right apply to other individuals who receive public dollars?
The fact is that when someone receives public dollars, they should be accountable to the public. That principle should apply to physicians as it does to other public employees. Accountability has long been argued as the reason to make public sector employee data widely available. And public accountability has an important role in the wise use of public dollars. Making the Medicare provider database available could help achieve many important public goals. Such data would provide researchers and policy analysts the opportunity to study health care trends in easily accessible ways, to not only identify potential fraud (a useful outcome in and of itself) but also to identify quality and care management improvement opportunities – something that could benefit patients and medical care overall.
Having access to the Medicare database should not and does not need to jeopardize patient information. Patient information can be protected while at the same time enabling a detailed review of provider practices. Such an approach is commonly adopted whenever Medicare makes its data available to health care researchers. The Wyden/Grassley approach would simply make such uses easier and more widely available. What a radical and good idea! If approaches like this can move forward in a bipartisan way, there is a real possibility the Affordable Care Act can be truly strengthened and given an even better chance of meeting the goals of improving access, enhancing quality of care, and moderating health care cost trends.
Ah, what a great outcome that would be!