Tuesday, April 11, 2006

Employers Push White House to Disclose Medicare Data

The New York Times
Employers Push White House to Disclose Medicare Data

WASHINGTON, April 10 — The White House is clashing with the nation's largest employers over their request for huge amounts of government data on the cost and quality of health care provided by doctors around the country.

President Bush has repeatedly urged private insurers to disclose such data, saying it will help consumers choose doctors and hospitals. But Medicare, the nation's largest insurer, has turned down a request for its data from the Business Roundtable, whose member companies provide coverage to more than 25 million people.

Employers want to use the data to compare and rate doctors and to rein in soaring health costs — the very purpose advocated by the president. The data would show, for example, which doctors performed the most knee operations with the fewest complications. Employers said they could then compare the average cost per case for different doctors. And they could steer patients — workers, and retirees and their dependents — to doctors who achieved the best results and offered the best value.

"The Medicare data would be a gold mine of information," said Maria M. Ghazal, director of public policy at the Business Roundtable. Medicare handles more than a billion claims a year.

Administration officials said they shared the employers' goals, but were constrained by court rulings that limited the disclosure of data showing Medicare payments to individual doctors, identified by name. Employers disagree, saying those court rulings are no longer relevant.

Touring the country in recent weeks, Mr. Bush has said the best way to control health costs is to "empower consumers" with information. "You can't make good health care decisions unless there's transparency in the marketplace," he said on Wednesday in Connecticut.

The White House has said that doctors, hospitals and insurance companies should "make information about prices and quality readily available to all Americans."

That sentiment gets passionate support from the Business Roundtable, which represents chief executives from 160 of the nation's largest companies, including Citigroup, Exxon Mobil and General Electric. Health benefits are a major expense for these companies.

"The Centers for Medicare and Medicaid Services should release 100 percent of the Medicare claims database," said Robert W. Lane, chairman of Deere & Company, the world's largest maker of farm equipment and a member of the Business Roundtable. "This is essential to measuring cost efficiency and compliance with clinical guidelines."

At a recent White House meeting, Mr. Bush asked business executives to support his campaign for the disclosure of data on health costs and quality. In response, they asked why Medicare had not released its data.

Last year, before Mr. Bush started talking about "transparency in the marketplace," the Business Roundtable asked for access to the full Medicare claims database.

Michael O. Leavitt, the secretary of health and human services, said the volume of doctor claims was so large that "we cannot produce a single file larger than 5 percent of the total."

Moreover, federal officials said, the data could be released only for bona fide research projects and even then the claim files would not identify doctors by name. So they could not be used to produce profiles of doctors, or report cards.

Geralyn M. Barosso, a technical specialist at Medicare's Research Data Assistance Center, said, "Medicare data has not been released for the purpose of profiling individual physicians."

Federal officials said they were still bound by a 1979 ruling in which a federal district judge blocked the disclosure of information about Medicare payments to individual doctors. Such disclosure was "prohibited by the Privacy Act" because it would "constitute a clearly unwarranted invasion of personal privacy," the court said.

The law protects the privacy interests of doctors as well as patients, the court said.

Christina Pearson, a spokeswoman for the Department of Health and Human Services, said the administration was reviewing that decision.

Peter V. Lee, chief executive of the Pacific Business Group on Health, a coalition of employers, said he had repeatedly urged the Bush administration to make available the full Medicare claims database, stripped of information that could identify patients.

"To measure performance accurately, you need big numbers," Mr. Lee said. "The best source of big numbers is Medicare. One employer may have 12 patients seen by a particular doctor. Medicare may have 100 patients treated by the same doctor. If you combine the information, you get a much better picture of the doctor's performance."

Consumer groups and labor unions also want the Medicare data. "We have a shared interest," said Debra L. Ness, president of the National Partnership for Women and Families. "Medicare and private health plans could save billions of dollars if just one in 10 beneficiaries moved from less efficient to more efficient physicians."

Medicare has Web sites to help consumers compare hospitals, nursing homes, home health agencies and kidney dialysis centers. But it has no site comparing doctors.

Employers say the 1979 court case is no longer relevant because Medicare has changed the way it pays doctors, and most doctors now practice in professional corporations, which are not protected by the Privacy Act.

"Times have changed," Mr. Lee said. "The administration should take a hard look at that case and its outdated interpretation of the privacy law."

Researchers have found immense variation in the amount and cost of care provided by different doctors to Medicare patients with the same disease and the same severity of illness. Patients who receive more care — more office visits, hospitalizations and operations — do not necessarily fare better.

Dr. John E. Wennberg of Dartmouth Medical School, who has studied such variations for more than 30 years, said the Business Roundtable was making "a splendid effort" to compare health care providers. But Dr. Wennberg said: "I would caution against simplistic efforts to measure efficiency. It's very difficult to get reliable data on cost and quality at the individual physician level."

Conclusions are more likely to be valid when researchers compare groups of 25 or more doctors, Dr. Wennberg said, and it is also essential to know how frequently doctors admit patients to hospitals.

Even among surgeons performing similar procedures on the same kinds of patients at the same hospital, costs often vary widely.

Dr. Bruce L. Hall, assistant professor of surgery at Washington University in St. Louis, suggested one reason: Doctors treating the sickest patients seem to develop "costly practice habits," which show up even when they are caring for healthier patients.