HHS Must Share Provider Investigation Findings with Medicare Beneficiaries
A federal judge has ordered Medicare officials to disclose findings when they investigate beneficiaries' complaints that doctors or hospitals provided "poor-quality" care or made medical errors that injured patients, the New York Times reports. The ruling, issued by Judge Ellen Huvelle of the Federal District Court in Washington, D.C., overturns a more than 20-year-old policy that has prevented Medicare beneficiaries from "obtaining data on doctors who botched their care"(Pear, New York Times, 7/17). Current rules state that peer review organizations, the entities under Medicare that investigate quality complaints, may only disclose information about a physician "with the consent of that practitioner," effectively limiting medical error disclosure to patients. Although the Clinton and Bush administrations had supported the policy, citing "secrecy" as "essential to the peer review process" that doctors use to evaluate one another, Huvelle ruled that the policy violated the federal Medicare statute. She said that under federal Medicare law, Medicare officials must provide beneficiaries who file complaints with the "final disposition" of an investigation, regardless of whether doctors offer their consent. Huvelle ordered HHS Secretary Tommy Thompson to send a letter within 20 days to peer review organizations that investigate Medicare complaints, telling them that they must also disclose the results of investigations to beneficiaries who file complaints. "The [Medicare] statute requires a [peer review organization] to inform a beneficiary complainant of the substantive disposition of their complaint," Huvelle said. Patients also may use the information in medical malpractice lawsuits, the Times reports Although the New York Times and the Associated Press reported in January that HHS would voluntarily reverse the disclosure policy, no changes occurred after HHS officials "stressed emphatically" that the news reports were incorrect (New York Times, 7/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.