A fight over healthcare data

Times Staff Writer

Although President Bush has repeatedly called for helping consumers make better decisions about healthcare, his administration is appealing a groundbreaking court ruling that would permit disclosure of Medicare billing records so patients could compare doctors’ expertise and efficiency.

Release of such information is advocated by consumer groups, employers and the health insurance industry, but is opposed by organizations representing doctors. Consumer and business groups said they were disappointed by the administration’s appeal. The American Medical Assn. has petitioned to join it.

With information on more than 40 million patients and 700,000 doctors, the Medicare claims database is considered the mother lode of healthcare data, richer than the computer banks of big insurers. It could reveal, for example, how often a doctor has performed a given procedure -- such as knee surgery or cardiac catheterization -- a statistic considered a key indicator of how good a physician is likely to be.


But release of such details has been limited by government policy, based partly on a 1970s court ruling that sought to protect the privacy of doctors’ financial information.

In the current case, a group called Consumers’ Checkbook sued the government for data on doctors in four states and Washington, D.C.

Last summer, U.S. District Court Judge Emmet G. Sullivan ruled that the 1970s decision addressed a different set of facts and therefore did not apply to the consumer group’s request. Sullivan ordered the administration to release the data, saying the information would provide “a significant public benefit.”

The government filed its appeal with little fanfare this week in the U.S. Court of Appeals here.

In an unusual statement, the Health and Human Services Department endorsed the objectives of the consumer group that is suing, but said it wanted a higher court to clarify the lower-court rulings.

“We’re caught between court decisions,” said Christina Pearson, a spokeswoman for the department. “There’s conflicting information from different courts, so we’re pushing to get clarity.”

But the government’s legal brief in the case calls for the appeals court to reverse Sullivan’s ruling, leaving the restrictions on the release of data in place.

Robert Krughoff, president of Consumers’ Checkbook, said the government could have simply accepted Sullivan’s ruling and left it to doctors’ groups to try to overturn the decision on appeal. Releasing the data, he added, would be consistent with positions previously taken by Bush and Health and Human Services Secretary Mike Leavitt favoring transparency in healthcare.

“I know the government was under a lot of pressure from the AMA in particular, arguing that the government should appeal,” Krughoff said. “Whether that’s the reason the government appealed, I don’t know.”

Pearson acknowledged the opposition from doctors, but said the administration’s interest was in getting legal clarity.

The American Medical Assn. argues that the Medicare information could be misleading because the raw numbers did not take into account differences in patients treated by different doctors.

A skilled physician who tackles the most dire cases could wind up with a lower success rate than a less able doctor who treated patients in less severe condition.

Pearson said Medicare had released more extensive consumer information under Bush than under previous presidents. She pointed to government Internet sites that allowed patients to compare hospitals and nursing homes.

Krughoff said the information sought by his group was more detailed and would be provided to consumers through an independent source.

“The government advises consumers to check this kind of information, but the patient is now at the mercy of asking the doctor, and maybe challenging the doctor, as opposed to going to an independent source and finding out,” he said.