Federal Court OKs Access to Medicare Doctor Claims Data

The U.S. District Court for the District of Columbia has ruled that HHS must release Medicare physician claims data for Illinois, Maryland, Virginia, Washington state and Washington, D.C., a decision that could help the public evaluate the performance of the program and the physicians, the Wall Street Journal reports.

In the case, Consumers' CHECKBOOK/Center for the Study of Services filed a lawsuit to obtain access to the data. HHS argued that the release of the data would violate the privacy of physicians. However, the court rejected that argument because Medicare claims account for only a portion of the incomes of physicians.

According to the court, the release of the data would "help the public make more informed Medicare decisions" and provide "more information of how government funds are spent."

The group plans to post the data, which HHS must release by Sept. 21, online for public use. Researchers could analyze the data to determine the number of times physicians perform certain procedures and to compare the mortality rates among patients of certain physicians, and health plans could use the data to improve their analyses of physician quality.

The group has requested similar data for the other 46 states.

An HHS spokesperson said that the department has begun to review the decision and has not decided whether to appeal.

An American Medical Association spokesperson said that the group also has begun to review the decision (Zhang/Francis, Wall Street Journal, 8/25).

According to the Washington Post, the decision "could spur development of online reference tools that help patients evaluate physicians based on the volume of procedures they do," although such tools "would have limitations" because, among other issues, procedures that physicians performed on "non-Medicare patients would not show up" (Lee, Washington Post, 9/1).

In addition, the decision could transform the "relationship between doctors and patients, as well as the business of health care," the Los Angeles Times reports (Alonso-Zaldivar, Los Angeles Times, 8/30).