Consumer group vows to mine Medicare data
US court said disclosure would imperil privacy
WASHINGTON - A consumer group seeking Medicare billing records as a way of evaluating and grading doctors on quality said yesterday it is not giving up despite an appeals court reversal.
The case is being closely watched as an important battle in the effort to reshape the nation's healthcare system. Consumer advocates, employers and insurers argue that access to Medicare claims filed by doctors' offices could help independent groups monitor quality and ferret out waste. Patients would not be identified.
But doctors are worried that such disclosures would violate their privacy and that resulting ratings could portray some physician's offices inaccurately.
The nonprofit Consumers' Checkbook group won a lower-court ruling in 2007 that directed the government to release the records under the federal Freedom of Information Act. The federal Health and Human Services department, joined by the American Medical Association, appealed. In a split decision issued late Friday, a three-judge panel of the federal appeals court for Washington, D.C., handed the consumer group a defeat.
The judges said freedom of information laws are mainly intended to shed light on government operations, not the workings of private businesses.
"The requested data does not serve any [freedom of information-related] public interest in disclosure," Judge Karen LeCraft Henderson of the US Circuit Court of Appeals wrote for the majority. "We need not balance the nonexistent public interest against every physician's substantial privacy interest in the Medicare payments he receives."
Robert Krughoff, president of the consumer group, said he was "quite surprised" by the judges' reasoning, since healthcare costs and the quality of medical services are among the most pressing problems facing the government.
"The majority opinion seems to misunderstand how these data would be used," Krughoff said. "It doesn't accurately portray how the data can be used to monitor the quality of healthcare provided under the Medicare program." Krughoff said his lawyers are considering an appeal.
"This is a momentous victory for the privacy rights of physicians," said Jeremy Lazarus, a Denver psychiatrist and AMA spokesman. Medicare billing records are "basically raw data," he said. For example, added Lazarus, what if one doctor sees sicker patients than another? A simplistic ratings system might tar that doctor as a low-quality provider. But the doctor who takes the hardest cases may be the most skilled.